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Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa 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.
PURPOSE OF THE JOB
QUALIFICATIONS
REQUIRED QUALIFICATIONS Required Work Experience Experience in pharmacy or medical field
Level 1 - 3 years Levels 2 and 3 - 5 years Level 4 - 6 years
Experience in prescription benefit administration
Level 1 - 1 year Level 2 - 3 years Level 3 - 5 years Level 4 - 6 years
Experience working in vendor applications (rebate, web tools, formulary tools)
Level 2 - 1 year Level 3 - 2 years Level 4 - 5 years
5 years' experience in progressive responsibility with allocation of resources and participating in management of complex projects (Level 4) Required Education
Required Licenses
Required Certifications
PREFERRED QUALIFICATIONS Preferred Work Experience
Experience with a pharmacy benefit management or prescription claim administration
Levels 1 and 2 - 3 years Level 3 - 5 years Level 4 - 6 years
Experience with the current BCBSAZ PBM system
Levels 1 and 2 - 1 year Level 3 - 2 years Level 4 - 6 years
Experience with BCBSAZ claims software / systems
Level 2 - 1 year Level 3 - 2 years Level 4 - 6 years
Demonstrated experience handling confidential information
Level 1 - 2 years Level 2 - 3 years Level 3 - 4 years Level 4 - 6 years
Demonstrated experience handling vendor system coding and analytic functions
Level 3 - 5 years Level 4 - 6 years
5 years' demonstrated experience handling complex projects and allocation of resources (Level 4)
Preferred Education
Preferred Licenses
Preferred Certifications
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
LEVEL 1 - PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW
Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy Support internal and external customers with information on benefits applicable to medication claims Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines. Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals Communicate recommendations in regard to medication claim processing and benefit decisions. Monitor and investigate reported plan set up system issues Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested. Resolve escalated member issues Research & provide recommendations for accumulations issues Logs all benefit setup issues on error tracking reports Provide monthly updates on error resolutions and impact reports
LEVEL 2 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION
Communicates issues identified within vendor system effectively to team. Communicates issues identified within plan setup testing or another escalated research to team Strategizes solutions for issue resolution and communicates plans to team. Provides written documentation for desk levels. Provides support to other team members when necessary Review plan testing documents for minimal accuracy
LEVEL 3 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISON, ACTS AS SUBJECT MATTER EXPERT
Primary liaison for Pharmacy Management for applicable benefit design questions Primary SME contact for various internal departments within BCBSAZ In regard to pharmacy plan setup and design Builds reporting and analyzes data for benefit recommendations to management. Review and determine pharmacy benefit setup upon renewal for all benefit plans Build and setup all new pharmacy benefits in the pharmacy system; including standard patient pays Submit drug code assignments to enrollment for all benefit plans Maintain pharmacy drug code matrix
LEVEL 4 - LEAD - PERFORMS JOB FUNCTIONS AS ASSIGNED AND ALLOCATES RESOURCES AND PROJECT PRIORITIZATION
Perform quality checks and analysis on drug code setup from other analysts Review escalated plan testing questions for accuracy and make corrections as needed Setup all complex pharmacy benefit plan designs Setup all complex patient pays, and any other design element related to complex pharmacy benefits Works with Pharmacy Management Leadership team to identify project prioritization Allocates resources to ensure required work is accomplished within defined time frames Assigns Tasks to Analysts and Specialists as needed
ALL LEVELS
Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels. Properly track all pharmacy benefit issues & concerns 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. Perform all other duties as assigned. competencies REQUIRED COMPETENCIES Required Job Skills
Intermediate PC proficiency with word processing, spreadsheets, and claims and imaging software (Level 1) Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (all Levels) Advanced PC proficiency, including spreadsheet and vendor application software (Levels 2 and 3)
Required Professional Competencies
Take initiative Establish and maintain working relationships in a collaborative team environment Flexibility in prioritization of workflow Compose a variety of business correspondence
Required Leadership Experience and Competencies
PREFERRED COMPETENCIES Preferred Job Skills
Preferred Professional Competencies
Effective interpersonal communication Multicultural sensitivity Claim system experience with pharmacy vendor software and/or systems (Levels 2 - 3)
Preferred Leadership Experience and Competencies
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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Blue Cross Blue Shield of Arizona
Feb 18, 2026