Mgr, Out of Network Open Negotiation & Arbitration - HYBRID

Overview

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and businesses, and provides information and tools to help individuals make better health decisions.

AZ Blue has a hybrid workforce strategy, Workability, offering flexibility with how and where employees work. Positions are classified as hybrid, onsite or remote. Onsite requirements may change based on business needs, but most employees should expect onsite requirements at a minimum of once per week.

This position is hybrid within the state of AZ only and residency in Arizona is required.

Purpose of the Job

The Manager leads the organization\'s management response to the NSA including managing provider inquiries, open negotiation requests, disputes, and arbitrations. This position is responsible for ensuring timely and accurate arbitration submissions, responding to federal inquiries, and making recommendations to leadership regarding final offer amounts, claims disputes, and contracting strategy.

Responsibilities (Essential Job Functions and Responsibilities)

• Oversee daily NSA activities, provide direction and training to staff responding to NSA related activities.
• Use pertinent data and facts to identify and solve a range of issues and to identify opportunities.
• Perform claims research, respond to arbitrator inquiries related to NSA, provider inquiries and internal claims teams.
• Prioritize and organize your own work and work of the NSA staff to meet deadlines.
• Participate in development and maintenance of NSA policies and procedures, desktops, and workflows.
• Review and respond to arbitration requests.
• Define, initiate, and direct analysis of offers and claims to assess appropriate action related to NSA.
• This position includes direct supervisory capacity over a team of ten (10) or more staff, consisting of full-time employees and contract workers.
• Perform all other duties as assigned.
• The position has an onsite expectation of 2 days per week and 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.

Qualifications

Required Qualifications

Required Education

Required Licenses

Required Certifications

Preferred Qualifications

Preferred Work Experience

Preferred Education

Essential Job Functions and Responsibilities

Competencies

Required Competencies

Required Professional Competencies

Preferred Competencies

Preferred Job Skills

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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