Health Services Technician (Justice Technician) - Remote AZ

Blue Cross Blue Shield of Arizona•Phoenix, AZ

3d•Remote

About The Position

Responsible for research and triage of records and other documentation to ensure requests are processed accurately, timely, professionally and according to regulations. Works with team, providers and members to provide services that put our member first. The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

Requirements

Level 1: 1 year Experience in healthcare, health insurance, or related customer service
Level 2: 3 years Experience in healthcare, health insurance, or related customer service
Level 3: 5 years Experience in healthcare, health insurance, or related customer service
High School Diploma or GED in general field of study (All Levels)
Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones
Intermediate PC proficiency
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
Interpret and translate policies, procedures, programs and guidelines
Capable of investigative and analytical research
Navigate, input and maintain data records in multiple system applications
Follow and accept instruction and direction
Establish and maintain working relationships in a collaborative team environment
Residency, and work to be performed, within the State of Arizona.

Nice To Haves

Level 1: 2 years Preferred Work Experience
Level 2: 4 years Preferred Work Experience
Level 3: 6 years Preferred Work Experience
1 year / 2 years / 3 years experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field
Associate's Degree in general field of study
Intermediate understanding of medical terminology
Intermediate comprehension of anatomy and medical practices
Knowledge of a wide range of subjects pertaining to the organization's service and operations
Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
Ability to build synergy and interdependence with a diverse team, in a changing environment

Responsibilities

Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
Answer a diverse and high volume of health insurance customer calls or correspondence on a daily basis.
Maintain complete and accurate records per department policy.
Maintains member information in a confidential manner and ensures HIPAA compliance at all times.
Meet quality, quantity and timeliness standards to achieve individual and departmental performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, community resources, provider networks, etc.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Research, gather and conduct preliminary analysis of data for department and corporate reporting.
Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
Ensure confidentiality and control access to sensitive information.
Maintains productivity and accuracy requirements set for this level.
Assists in development of procedures and/or desk levels for assigned processes, as needed and develops and assists in implementation of new policies and/or desk levels.
Maintains effective communication (verbal and written), both formal and informal with internal and external customers.
Maintains knowledge of activities in assigned area and possesses the ability to provide assistance as necessary.
Able to work effectively and collaboratively with interdisciplinary teams.
Positively adapts to a changing work environment with flexibility and recognizes the impact the change will have on the department process.
Adapts to changing work environment with flexibility and recognizes potential impact with ability to accentuate the positive to maintain/increase staff morale.
Collaborate with team to distribute workload/work tasks
Monitor and report team tasks
Communicate team issues and opportunities for improvement to supervisor/manager
Support/mentor team members
Assists in departmental training of new staff and ongoing in-services.
Assists in revising current policies and procedures and/or desk levels, as needed and develops and assists in implementation of new policies and/or desk levels.
Attends and actively participates with interdepartmental teams.
Takes on special projects as requested by management.
Analyzes and monitors authorizations, requests or referrals for trends. These trends may illustrate an educational need; need for a referral to a different BCBSAZ department; need for updating a policy/guideline.
Makes specific written recommendations to Manager with demonstrated ability to follow through on ideas.
Demonstrates ability, under minimal direction to perform special projects, train new staff, analyze inventory, revise current policies and procedures and/or desk levels and develop and implement new policies and/or desk levels.
Takes initiative to follow through on issues and identifies opportunities for improvement.
Consistently serves as a SME and resource to team members when questions arise regarding departmental policies and procedures.
Demonstrates resourcefulness, diplomacy, organizational and analytical skills.
Perform all other duties as assigned.