EDI Technical Analyst (Claims) - Hybrid

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 small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

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.

Level 1 – Entry-level role; Performs job functions under close supervision or peer review

PRODUCTION SUPPORT

• Track and resolve basic or routine processing problems, coordinating with all areas.
• Research, analyze, track and resolve basic production problems.
• Develop business objectives, processing requirements, and technical specifications.
• Analyze files and map data from one system to another.
• Responsible for production cycles, solving production incidents and notification of problems.
• Write SQL queries needed for production support.
• Ability to query Splunk and App insight for logging results.

QUALITY ASSURANCE

• Develop basic test data.
• Process test files and analyze test results.
• Create test files
• Able to use standard API testing tools like SOAP UI or Postman
• Perform execution of test cases/scripts; document results, log defects, and regression testing of defects.
• Perform test execution and defect reporting utilizing testing tools.
• Assist with root cause analysis and triage of key/critical defects for quick turn-around.
• Monitor and track traceability of business requirements to text execution.
• Participate in defect review meetings to explain and/or demonstrate defects.
• Develop and maintain SQL queries to test results and to create mock up data for testing and reporting.

Technical Analysis

• Assist with technical and data centered research required to produce and test Trading Partner files.
• Understand and apply TR3, Core CAQH and Blue Exchange rules.
• Learn business and systems data and process flows; and how they affects surrounding systems and operational areas.
• Research and analyze application procedural problems and provide recommendations for improvements and changes.
• Develop functional & technical specifications, logic flows and other documentation as applicable.
• Create Mapping Documents to move data between systems
• Synthesize complex or diverse information, collect and research data, use intuition and experience to complement data, work flows and procedures.
• Review computer system capabilities, workflow and scheduling limitations to determine if requested application or application change is possible within the existing system.
• Translate business needs into technical solutions with knowledge of programming languages (SQL, C# or VB.net, ETL, SOA, and OLAP).
• Participate in maintaining operational and disaster-recovery procedures.
• Write or modify procedures for internal use, operational procedures, and computer operations, as applicable.
• General understanding of cloud platforms, including AWS, Azure, kubernettes

PROJECT MANAGEMENT

• Participate on small to large scoped projects.
• Use sound project management methodology and demonstrate solid time management skills.
• Create and deliver presentations.
• Monitor and create priority list(s) that are agreed to by user management.

Level 2 - Performs job functions with general supervision and peer review

• Research, analyze, track and resolve moderately complex production problems.
• Work with IT Infrastructure team to develop and implement effective production monitoring.  Including balance and control dashboarding, monitoring and alerting of API’s, data loads, Trading Partner transactions and any other process required to ensure our customers get the data required.
• Working knowledge of specific trading partner process flow.
• Working knowledge of various application integration for EDI. i.e. Portal, IVR, console apps, etc.
• Research transactions to troubleshoot issues or analyze for data trends.
• Ensure the department leverages internal tools and applications effectively.
• Build, support, and maintain moderately complex processes, programs, and data.
• Participate or lead medium to large scoped projects.
• Create moderately complex ad-hoc reports for internal usage and external usage.
• Develop project plans, time estimates and project schedules based on prioritization and business requirements.
• Research and become proficient in one or more applications or data marts.

Level 3 - Performs job functions with moderate supervision

• Complete tech discovery with enough detail for development teams.
• Create Dashboards for monitoring transactions or performance on pieces of a transaction for the overall health of our process.
• Research, analyze, track and resolve high complex production problems
• Work with IT Infrastructure team to develop and implement effective production monitoring.
• Ensure the department leverages internal tools and applications effectively
• Build, support, and maintain moderately complex processes, programs, and data
• Participate or lead Large scoped projects
• Create complex ad-hoc reports for internal usage and external usage
• Develop programs, time estimates and project schedules based on prioritization and business requirements

Level 4 - Performs job functions with minimal supervision

• Facilitate and/or create new procedures and processes that support advancing technologies or capabilities.
• Research, analyze, track and resolve complex production problems.
• Build, support, and maintain complex processes, programs, and data.
• Evaluate high-level project information and assess project components to forecast work effort required.
• Provide peer-level review and mentoring to levels 1 – 3.
• Participate and/or lead complex technical projects.
• Create complex ad-hoc reports for internal usage and external usage.
• Act as a subject matter expert in two or more of areas as assigned:
  • BI Production Reporting
  • Application Architecture
  • Application Architecture and Support
  • Training

Lead - Performs job functions in a lead capacity

• Act as primary operational contact for internal and external customers when needed or in the absence of manager.
• Ensure Service Level Agreements between department and operational or technical areas are met.
• Lead, develop and mentor staff by providing opportunities for growth through delegation, training, and assignment to various project teams.
• Inform manager of any issues impacting the efficient and effective performance of the department including system, resource, and informational barriers; Provide timely feedback to team member on performance.
• Assist the manager in the day-to-day operations of the department.

ALL LEVELS

• Understanding of EDI transactions.
• Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
• Maintain current on new developments in technology-related industries.
• Participate in corporate quality and data governance programs.
• The position has an onsite expectation of 1 day 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. Participate in on-call rotation.
• Participate in on-call rotation.
• Perform all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills (Applies to All Levels)

• Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
• Intermediate PC proficiency.
• Intermediate proficiency in spreadsheet, database, flow charting, and  word processing software.
• Intermediate knowledge of data mapping techniques and data analysis software.
• Intermediate knowledge of computer operating systems.
• Intermediate knowledge of Microsoft Applications and Suites, Windows Server, and Microsoft SQL databases.

Required Professional Competencies (Applies to All Levels)

• Strong analytical skills to support independent and effective decisions.
• Ability to rapidly pick up new technologies
• Ability to prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
• Perseverance in the face of resistance or setbacks.
• Effective interpersonal skills and ability to maintain positive working relationship with others.     
• Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
• Systems research and analysis. Ability to write and present business intelligence documentation.
• Demonstrate the ability to stay current on global threats and vulnerabilities.
• Experience working with and managing third parties.
• Knowledge of business requirements development and user acceptance testing.
• Maintain confidentiality and privacy.
• Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data.
• Understanding of data governance best practices and data quality improvement principles.

Required Leadership Experience and Competencies

• Facilitate and resolve customer requests and inquiries for all levels of management within the Corporation. (Applies to Levels 2 - 4)
• Build synergy with a diverse team in an ever changing environment. (Applies to Levels 3 - 4)

PREFERRED COMPETENCIES

Preferred Job Skills (Applies to All Levels)

• Knowledge of HIPAA regulations
• Advanced proficiency in spreadsheet, SQL queries, database, flow charting, and  word processing software
• Advanced knowledge of data mapping techniques
• Advanced knowledge of computer operating systems
• Advanced knowledge of decision support systems
• Advanced knowledge of programming, database systems, and data management.
• Advanced knowledge of the Edifecs EDI platform

Preferred Professional Competencies (Applies to All Levels)

• Advanced systems research and analysis expertise
• Impeccable project management skills
• Solid technical ability and problem solving skills
• Knowledge of internal departments and operations
• Strong technical documentation skills and a strong ability to translate technical concepts so that they are easily understood by laypersons

Preferred Leadership Experience and Competencies (Applies to Levels 3-4)

• Ability to provide mentoring and peer review to junior team members
• Ability to build lesson plans and deliver lessons to junior team members

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.