Medicaid Customer Service Improvement Manager - Remote-AZ

Blue Cross Blue Shield of Arizona; United States; Hybrid; USD 100,000 - 140,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a seasoned leader to oversee complex customer service process improvements within the Medicaid segment. You’ll work with Medicaid Customer Service leaders to enhance the customer experience, monitor key metrics, and guide cross‑functional collaboration to implement service enhancements.

The role emphasizes coaching staff, reporting on performance, and driving initiatives that improve First Call Resolution and customer satisfaction.

Qualifications

• 7 years of experience in health insurance operations.
• 5 years of supervisory or management experience.
• 3 years of process management experience.
• Bachelor’s/Associates degree not required but preferred in related fields.

Responsibilities

• Provide oversight for complex customer service process improvement projects.
• Collaborate with Medicaid Customer Service leaders to improve customer experience.
• Monitor key metrics: First Call Resolution, CXI, Net Promoter Score.
• Document and improve processes; coordinate with department leads and trainers.
• Support staffing, resource allocation, and performance management.

Skills

Health insurance operations

Supervisory leadership

Process management

Customer service metrics

Education

High School Diploma or GED

Job description

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

Provides oversight and guidance for complex customer service process improvement and segment wide projects. Works with the Medicaid l Customer Service leaders to improve the customer’s experience, monitors and targets improvement on key metrics, and identifies key customer needs. Facilitate information exchange and issue resolutions between internal business partners.

REQUIRED QUALIFICATIONS

Required Work Experience

• 7 years of experience in health insurance operations
• 5 years of supervisory or management experience
• 3 years of process management experience

Required Education

• High School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 10 years of experience in health insurance operations
• 7 years of supervisory or management experience
• 5 years of process management experience

Preferred Education

• Bachelor's Degree in general field of study

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Support leadership with championing and implementing strategic initiatives and providing clear direction to customer service staff on success and protocols for tracking and reporting results. Monitor activities supporting efforts to improve and maintain success in First Call Resolution, Customer Experience Index, and Net Promoter score. These activities include routine report analytics, engaging team lead(s) in developing tactics for implementing service enhancements, developing methods to measure efficacy of service strategy tactics, and establishing protocols for communicating employee‑coaching needs across the department. Work with the Customer Service management teams to document and improve processes. Ensure that new and/or improved processes are sent to customer service representatives in a timely and effective manner. Create and provide training as applicable. Support Customer Service management and provide guidance and oversight of department resource allocation to support corporate and departmental goals and objectives. This includes accountability for ensuring IOS ticket resolution, as well as accountability for coordinating with team leads and resource planning support to execute strategies for effectively managing claims, customer calls, and correspondence inventories. Provide claims and/or correspondence reporting while monitoring and improving metric results. Develop and communicate business cases to support recommendations for change to current business practices and processes. Respond to large group audits and RFPs as needed. Represent the department in meetings and decision‑making processes as it relates to the specific area of responsibility. Demonstrate a high degree of professional presence. Make appropriate decisions based on information at hand with the ability to focus on the big picture while looking for opportunities for improvement. Think outside the box and objectively and professionally challenges the status quo that engages others in constructive dialogue to achieve results. Build and foster good working relationships with internal customers and peers. Work collaboratively with partners across the organization to provide data support, analysis, tracking, trending, reporting, and recommendations to drive the decision‑making and prioritization of commercial growth initiatives. Identify areas of customer need and insight. Prioritize and develop actions plans for targeted solutions. Advance the segment culture towards one of accountability, collaboration, results‑orientation, and most importantly customer centricity. Coordinate activities between multiple departments to achieve the desired results. Supports leaders in performance management of staff Provide in depth Claims, Correspondence, and Customer Service knowledge to staff in order to strengthen and refine the knowledge within the team. Maintain effective working relationships to ensure teamwork in achieving corporate goals. The position 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. Manage the day‑to‑day and future customer service improvement activities with leaders engaged in customer service operations. Identifies and coordinates training needs, coaching and assists leaders by recommending disciplinary actions based on individual and team performance trends. Evaluate and make recommendations regarding employment decisions. Perform all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills

• Extensive knowledge of the health insurance industry
• Excellent problem‑solving and investigative skills
• Excellent relationship building and communication skills
• Strong skills in influencing others across teams
• Strong written and verbal communication
• Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
• Intermediate skill in word processing, spreadsheet and database software
• Intermediate PC proficiency

Required Professional Competencies

• Ability to think critically and rise above challenges with a customer‑centric focus toward achieving results
• Strong familiarity with contact center metrics including ASA, Service Level, and First Call Resolution
• Ability to effectively delegate and own accountability for ensuring work is being accomplished through others
• Strong interpersonal and active listening skills. Establish and maintain working relationships in a collborative environment
• Ability to manage process improvement projects and mentor people effectively
• Maintain confidentiality and privacy

Required Leadership Experience and Competencies

Prior management experience Translate daily work into impact on organization’s mission, vision and values

Preferred Competencies

Preferred Job Skills

• Professional writing skills
• Advanced technical and professional mentoring and coaching skills

Preferred Professional Competencies

• Experience with managing, leading and continuously developing high performance teams
• Familiarity with Affordable Care Act policies, CMS requirements
• Intermediate to advanced knowledge of health insurance enrollment operations systems and transactions
• Familiarity with BCBSAZ commercial products and services

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.

Imagine doing life‑changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross Blue Shield of Arizona