Required Work Experience 4 years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level I)
6 years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level II)
8 years of experience in healthcare operations with a strong focus on claims processing, payment integrity, or claims analysis (Level III)
Demonstrated experience across the full claim's lifecycle within a healthcare payer environment (All Levels)
Experience analyzing claims data, identifying payment issues, and supporting operational or audit-driven resolutions (All Levels)
Required Education High-School Diploma or GED in general field of study (All Levels)
Required Licenses
N/A
Required Certifications
Preferred Work Experience (All Levels) Experience in payment integrity, claims auditing, coding support, or recovery operations
Experience working with claims adjudication systems, enrollment systems, or payment integrity vendors
Exposure to process improvement, rework operations, or system enhancement initiatives
Preferred Education Associate's or Bachelor's Degree in Business, Healthcare Administration, Information Systems, or related field (Level II-III)
Preferred Licenses N/A
Preferred Certifications CPC, CIC, CCS, or similar coding or payment integrity-related credentials (Level II)
Lean Six Sigma White/Yellow Belt (Level II-III)
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Level I
Demonstrates solid working knowledge of claims processing and payment integrity concepts.
Independently analyzes claims issues and supports audits, rework, and reporting.
Requires limited guidance for routine to moderately complex work.
Analyze claims processing workflows to identify payment risks, rework drivers, and systemic defects across all lines of business.
Support or lead claims rework and adjustment activities, ensuring accurate resolution and timely completion.
Communicate complex claims and payment integrity topics clearly to both technical and non-technical stakeholders.
Level II
Applies advanced claims lifecycle knowledge to complex payment integrity and rewor
Benefits
Health insuranceRemote work options
Additional Information
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 remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
The Payment Integrity Operations Analyst is responsible for supporting payment accuracy and operational effectiveness across the healthcare claims lifecycle, from intake and adjudication through post-payment review, recovery, and provider/member resolution.
This role partners closely with Claims Operations, Payment Integrity, Analytics, Clinical/Coding SMEs, and Technology teams to identify claim processing issues, payment risks, and rework opportunities. The analyst applies deep claims knowledge to analyze workflows, validate outcomes, support audits and recoveries, and drive sustainable improvements that reduce provider abrasion, improve member experience, and protect plan assets.
Key Focus Areas
End-to-end claims lifecycle expertise (pre‑adjudication, adjudication, post‑payment, adjustments, recoveries)
Payment Integrity operations and audit support
Claims rework and root-cause analysis
Data analysis and operational reporting
Cross-functional collaboration and issue resolution
Bcbsaz · AZ Blue Phoenix, AZ 85021