BCBSAZ
Appeal and Grievance Coordination Research Reviewer - HYBRID
AZ Blue Phoenix, AZ 85021 · Full-time
Sponsorship not specifiedDetected 2 days ago
ComplianceCustomer SupportHIPAAResearchLeadershipCommunicationWritingClaims Management
About the role
- Our positions are classified as hybrid, onsite or remote.
- This position is hybrid within the state of AZ only.
- This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
Responsibilities
- Perform data corrections and claim adjustments related to appeals.
- Perform duties with limited supervision.
- Maintain knowledge of multiple lines of business, including fully insured, self-funded, ACA, and Blue Card products.
- Process records and document requests related to appeals and grievances.
- Maintain current knowledge of state, federal, Blue Card, accreditation, and BCBSAZ appeal and grievance requirements.
Requirements
- Required Work Experience:
- Required Licenses:
- Required Certifications:
Nice to have
- Preferred Work Experience:
- 2 years of experience in a lead or senior claims role (all levels)
- 3 years of experience in claims processing and correspondence using multiple claims systems (all levels)
- 3 years as a pharmacy technician or precertification technician
- Preferred Licenses:
- Preferred Certifications:
- LEVEL 1 - REVIEWER I
- Conduct research to resolve requests from members, providers, and other Blue Plans in accordance with regulatory and accreditation standards.
Skills
- Intermediate PC proficiency
- Intermediate use of office equipment such as copiers, fax machines, scanners, and telephones
- Intermediate proficiency in word processing, spreadsheet, and database software
- Intermediate written communication and letter-writing skills
- Advanced PC proficiency
- Advanced word processing, spreadsheet, and database skills
- Advanced written communication and letter-writing skills
- Professional Competencies:
- Maintain confidentiality and privacy
- Conduct investigative and analytical research
- Build collaborative working relationships
- Practice strong interpersonal and active listening skills
Benefits
- Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
- Analyze and research medical grievances and appeals for final resolution or referral to Clinical Medical Appeals and Grievance staff.
- Maintain advanced knowledge of multiple systems, including medical management and claims systems.
- Review medical records to determine if requested supporting documentation is sufficient.
- Maintain current knowledge of medical terminology.
- Research and assemble medical records, coverage guidelines, claims, and historical data for clinical review and legal proceedings.
- Maintain understanding of medical management and claims processing systems.
Company info
- Experience in a lead or senior claims role
- At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
This listing is sourced directly from BCBSAZ's careers page and normalized into a canonical job model.