Blue Cross Blue Shield of Arizona

Business Intelligence Developer

• Partner with business leaders and subject matter experts to understand reporting and analytics needs
• Gather, document, and analyze business reporting requirements
• Map business requirements to source data structures and develop data models across multiple data stores
• Design, build, and maintain dashboards and visualizations using BI applications such as Tableau or Domo
• Ensure dashboards are creatively designed and communicate the story behind the data
• Analyze report data for accuracy and report potential quality errors
• Participate in peer reviews to ensure reports are accurate before distribution
• Prioritize projects with business owners
• Partner with IT to identify and store required data sets
• Plan, communicate, and deliver data visualizations with stakeholders
• Communicate the status of assigned items and backlog items
• Provide analytics expertise and insights into data trends across operational segments
• Lead dashboard demonstrations and educational sessions
• Provide ad-hoc data analysis and support to business functions
• Perform other duties as assigned

Clinical Supervisor

• Provide clinical leadership, supervision, mentoring, and operational oversight to Behavioral Health Managers, Associate Counselors, and other behavioral health staff
• Ensure clinical supervision requirements comply with Arizona licensing regulations and organizational standards
• Conduct one-on-one meetings, performance evaluations, coaching, and professional development activities
• Monitor team performance, productivity, quality metrics, documentation standards, and patient outcomes
• Collaborate with clinic leadership, primary care providers, and support staff to improve integrated behavioral health services and patient experience
• Implement process improvements to enhance clinical effectiveness, operational efficiency, and patient satisfaction
• Serve as a behavioral health clinical resource and subject matter expert
• Support recruitment, onboarding, training, scheduling, and retention of behavioral health staff
• Participate in interdisciplinary care team meetings and guide complex patient cases
• Support implementation and effectiveness of the Collaborative Care Model across assigned Prosano Health Care Centers
• Coordinate with psychiatric consultants and primary care providers on evidence-based treatment planning and population health management
• Review clinical documentation for compliance with organizational, payer, professional, and regulatory requirements
• Support patient experience initiatives and resolve escalated behavioral health concerns
• Maintain compliance with HIPAA, accreditation standards, regulations, and organizational policies
• Provide direct patient care, including assessment, diagnosis, brief intervention, care planning, and treatment, as needed
• Conduct biopsychosocial assessments and use validated screening and measurement-based care tools
• Deliver brief evidence-based interventions including CBT, MI, and SFBT
• Develop, monitor, and modify individualized care plans
• Facilitate referrals and care coordination with specialty behavioral health providers and community resources
• Document patient encounters, treatment plans, interventions, outcomes, and recommendations in the electronic medical record
• Work a full-time schedule of at least 40 hours per week, potentially including extended hours
• Perform other duties as assigned

Behavioral Health Supervisor – Clinical Supervisor, East Valley

• Provide clinical leadership, supervision, mentoring, and operational oversight to Behavioral Health Managers, Associate Counselors, and assigned behavioral health staff
• Ensure clinical supervision requirements comply with Arizona licensing regulations and organizational standards
• Conduct one-on-one meetings, performance evaluations, coaching, and professional development activities
• Monitor team performance, productivity, quality metrics, documentation standards, and patient outcomes
• Collaborate with clinic leadership, primary care providers, and support staff to enhance integrated behavioral health services and patient experience
• Identify and implement clinical and operational process improvements
• Serve as a behavioral health subject matter expert in the primary care setting
• Support recruitment, onboarding, training, scheduling, and retention of behavioral health staff
• Participate in interdisciplinary care team meetings and advise on complex patient cases
• Support implementation and success of the Collaborative Care Model (CoCM)
• Coordinate with psychiatric consultants and primary care providers on evidence-based treatment planning and population health management
• Review clinical documentation for compliance with organizational, payer, professional, and regulatory requirements
• Support patient experience initiatives and resolve escalated behavioral health concerns
• Maintain compliance with HIPAA, accreditation standards, state and federal regulations, and organizational policies
• Provide direct patient care, including assessment, diagnosis, brief intervention, care planning, and treatment, as needed
• Conduct biopsychosocial assessments using validated screening and measurement-based care tools
• Deliver brief evidence-based interventions, including CBT, MI, and SFBT
• Develop, monitor, and modify individualized care plans
• Facilitate referrals and care coordination with specialty providers, community resources, and other services
• Document encounters, treatment plans, interventions, outcomes, and recommendations in the electronic medical record
• Work a full-time schedule of at least 40 hours per week, potentially including extended hours
• Perform other duties as assigned

Behavioral Health Supervisor – Clinical Supervisor, West Valley

• Design, develop, and maintain reporting and data analysis solutions for financial and clinical outcomes, network performance, care management, claims processing, operations, medical costs, utilization, authorization, risk adjustment, and claims data
• Partner with business leaders, Finance, departments, and subject matter experts to fulfill data requests and support data-driven decision-making
• Design and code queries and data sets using structured programming techniques and appropriate reporting platforms
• Develop, maintain, and enhance Business Intelligence reports, dashboards, visualizations, and analytical insights using tools such as Tableau, Qlik Sense, Qlik View, and Power BI
• Gather and document business requirements, develop work plans, execute unit tests, resolve processing issues, and track project status
• Participate in the Systems Development Life Cycle, data governance, quality programs, source-control procedures, and operational/disaster-recovery procedures
• Monitor, refresh, and distribute scheduled reports and data extracts
• Prepare technical, production-support, project, and reporting documentation
• Lead or participate in projects, presentations, process improvements, and decision-support tool development according to level
• Review code and reporting for standards, accuracy, functionality, and compliance
• Mentor lower-level employees and conduct training according to level
• For Level 6: lead stand-ups, oversee DevOps work queues and project requests, address roadblocks, respond to client reporting questions, and ensure outgoing reporting quality and accuracy

Senior Business Intelligence Developer – Medicaid

Auditor

• Plan, perform, report, and follow up on audit assignments
• Ensure financial statements and reports comply with corporate policy
• Evaluate internal accounting controls for efficiency and asset protection
• Ensure operational policies promoting company well-being are enforced
• Formulate audit plans and recommend areas for future audit efforts
• Prepare or revise audit programs and perform audit fieldwork
• Prepare time budgets for audit steps
• Draft audit reports and document audit work and workpapers supporting audit results and conclusions
• Review draft findings and recommendations with company management
• Evaluate management responses and suggest follow-up actions
• Participate in project and interdepartmental teams
• Assist Internal Audit management and external auditors
• Assist teams in meeting project deadlines
• Keep current with developments in the field
• Assist the IA manager with special projects
• Conduct the Annual Risk Assessment
• Lead annual external audit coordination
• Work closely with other departments to resolve questions or discrepancies
• Perform continuous risk assessments as needed
• Assist in formulating the audit plan for board presentation
• Perform sensitive high-level projects
• Analyze and assess the control environment of business processes
• Assist junior-level auditors and mentor employees at lower levels
• Perform other duties as assigned

Senior Auditor II

Product Manager

• Own the design and execution of product initiatives driving profitable growth and competitive differentiation in the large group commercial segment
• Manage the large group product strategy across network, benefit/value-add, navigation/advocacy, clinical/vendor point solutions, and experience-enabler domains
• Develop and maintain a 12–36 month roadmap with outcomes, success metrics, dependencies, investment tradeoffs, and leadership-ready recommendations
• Translate strategy into executable epics, initiatives, milestones, and cross-functional commitments
• Lead research and support large group network design, including tiering, steering, narrow/broad configurations, and employer/network customization
• Provide product leadership during network implementations, including scope definition, stakeholder alignment, readiness tracking, and launch governance
• Partner with Provider Partnerships, Legal, Operations, Sales, and Configuration teams to ensure network changes are feasible, compliant, and marketable
• Own financial performance for large group buy-up programs and value-add offerings, including value proposition, pricing/packaging, penetration goals, and margin guardrails
• Build or coordinate business cases and financial rationale and implement performance tracking
• Drive portfolio management by evolving, redesigning, repositioning, or sunsetting offerings
• Coordinate discovery for new product concepts involving member experience, pricing transparency, provider choice, quality signals, steerage, and navigation/advocacy
• Define capabilities, MVP scope, and differentiation strategy and validate concepts through research and stakeholder feedback
• Partner with Digital, Clinical, Operations, and vendors to design integrated experiences
• Maintain knowledge of Arizona large group dynamics, healthcare delivery, distribution, employer landscapes, and national carrier strategies
• Conduct competitive research and translate findings into product actions, roadmap changes, capabilities, messaging, and sales enablement
• Ensure initiatives are operationally sound and scalable through implementation playbooks, data flows, handoffs, and risk controls
• Lead launch planning and go-to-market readiness with Sales, Marketing, Account Management, and Operations
• Coordinate Agile delivery with technical implementation leads
• Work onsite one day per week on a full-time schedule of at least 40 hours per week

Strategic Product Lead – Large Group

Investigator

• Prevent, detect, and deter fraud, waste, and abuse involving Commercial, Government, FEP, Medicare, and Part D programs
• Support Special Investigations Unit day-to-day operations, including investigations, analysis, management, and special projects
• Triage referrals and assess appropriate disposition
• Research and investigate allegations of fraud, waste, and abuse
• Use claims-processing systems, medical coverage guidelines, payment policies, benefits, and provider contracts
• Apply data-mining techniques, statistical data analysis, and analytical software to identify potential fraud, waste, and abuse
• Develop leads and cases from fraud alerts and government and private sources
• Prepare summary reports, corrective action plans, and investigative findings
• Escalate high-risk tips, cases, and related issues to management
• Conduct desktop and on-site medical-record audits, surveillance, undercover work, and suspect and witness interviews
• Prepare cases for referral to law-enforcement officials
• Testify and provide depositions as an expert witness
• Maintain chain of custody and document every stage of investigations
• Create, update, and follow operating procedures, policies, confidentiality requirements, and security guidelines
• Develop materials and assist with fraud, waste, and abuse training
• Attend annual seminars and webinars and participate in corporate task teams
• At higher levels, conduct complex investigations, develop queries, evaluate data integrity, provide technical guidance, manage case-tracking systems, design trend-analysis reports, support reporting requirements, coordinate external post-payment claims reviews, and perform quality audits

SIU Investigator I

General

• Lead and coordinate technology initiatives across Prosano IT, multiple technology disciplines, business functions, vendors, and system platforms
• Manage scope, schedules, costs, requirements, and validation before and after deployment
• Coordinate teams and disciplines to meet project requirements, deadlines, and schedules
• Support adoption of new technology, practices, and processes
• Plan, direct, and coordinate activities within timeframes and funding parameters
• Track and manage projects using Gantt charts, risk registers, and project management tools
• Create presentations for multiple levels of leadership
• Produce governance and project documentation
• Take projects from initial conception through final implementation
• Define project scopes, objectives, plans, schedules, resource plans, and status reports
• Assign duties, responsibilities, and scope of authority to project staff
• Provide tactical and strategic input on planning and systems-related projects
• Manage subcontractors and their workforces when applicable
• Develop project artifacts such as MS Project schedules and automated dashboards
• Improve Information Technology processes, tools, and methodologies through innovation and continuous improvement
• Provide leadership feedback on team performance, resource needs, and delivery effectiveness
• Oversee development and implementation of IT practices and policies
• Support production operations and project resource planning
• Forecast project work effort and ensure service-level agreements are met
• Provide project management guidance and mentoring
• Lead, instruct, direct, and review team members' work
• Participate in performance reviews
• Lead departmental improvements and assist the Manager with day-to-day operations
• Develop staff, training materials, and onboarding strategies
• Participate in corporate quality and data governance programs
• Perform other assigned duties