ACA Program Integrity Coordinator - 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. PURPOSE OF THE JOB The ACA Program Integrity Coordinator serves as a subject matter expert for Affordable Care Act (ACA) program integrity, compliance deliverables, vendor performance, and service delivery oversight. This position manages day-to-day vendor relationships, monitors regulatory and contractual performance, supports annual Qualified Health Plan (QHP) and Open Enrollment readiness activities, validates vendor financial activity, and partners with internal stakeholders to identify risks, resolve issues, and drive accountable process improvement. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience Five years of experience in health insurance back-office operations, quality and compliance programs, product development, vendor management, financial operations, business operations, or a related field. Three years of experience leading process improvement or designing and implementing business processes according to customer or operational specifications. Experience working with vendor invoices, budgets, purchase orders, financial tracking, vendor performance, contracts, or service agreements. Experience supporting compliance, privacy, government programs, healthcare operations, legal matters, or regulatory deliverables. Required Education Bachelor’s degree in Business, Finance, Healthcare Operations, Healthcare Administration, or a related field. Required Licenses None. Required Certifications None. PREFERRED QUALIFICATIONS Preferred Work Experience Experience in health plan program management, URAC or NCQA requirements, delegation oversight, senior-level project management, outsourced vendor or business process outsourcing environments, or external relationship management. Experience with financial systems, invoicing tools, vendor management platforms, service-level agreement tracking, performance reporting, or dashboard development. Specialized training or certification from the Blue Cross Blue Shield Association. Advanced compliance or legal training. Project Management Professional certification or Professional Business Analysis certification. Preferred Education Master’s degree in Business, Finance, Healthcare Operations, Healthcare Administration, or a related field. Preferred Licenses None. Preferred Certifications None. ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES ACA Individual Segment Support Maintain current knowledge of ACA, Centers for Medicare & Medicaid Services, Federally Facilitated Exchange, and Qualified Health Plan regulatory requirements. Review regulatory guidance, operating manuals, training materials, and program updates, and translate requirements into clear actions for internal owners and business partners. Identify gaps in policies, procedures, controls, and documentation. Draft or update materials that support regulatory compliance and operational consistency. Coordinate audit responses, corrective action plans, and supporting documentation for internal, regulatory, and vendor-related audit obligations. Conduct research, analysis, data gathering, and issue investigation to support regulatory deliverables and leadership decisions. Vendor Relationship and Performance Management Serve as the primary day-to-day liaison for assigned ACA vendor relationships and vendor-supported products or services. Maintain documentation that clearly defines vendor contract objectives, deliverables, scope, roles, responsibilities, resources, performance expectations, and issue ownership. Monitor vendor performance against regulatory requirements, contractual commitments, service expectations, and service-level agreements. Develop and maintain vendor performance dashboards, scorecards, issue logs, action-item trackers, and recurring leadership reports. Engage vendors and cross-functional resources to resolve operational issues, escalate constraints or risks, and drive timely remediation. Financial Oversight and Contract Support Manage and track vendor purchase orders to ensure alignment with approved scopes of work, budgets, contracts, and delivered services. Review, validate, reconcile, and facilitate the timely processing of vendor invoices. Identify and resolve invoice discrepancies in partnership with vendors and internal stakeholders. Track vendor spending against budgets, forecasts, actual activity, credits, penalties, recoveries, and other financial impacts. Identify cost-saving opportunities through invoice validation, utilization review, performance insights, and contract accountability. Readiness, Projects, and Process Improvement Lead or support annual Qualified Health Plan filing, Open Enrollment readiness, vendor readiness planning, testing strategies, and related leadership status reporting. Coordinate multidisciplinary work across internal business areas, vendors, compliance, legal, product, technology, and operational stakeholders. Contribute to business requirements, user stories, test scripts, production-readiness validation, and final business approval for vendor-impacting solutions, as assigned. Lead or support project management activities, meeting facilitation, agenda development, pre-read distribution, meeting minutes, and action-item follow-up. Analyze performance trends, root causes, business impacts, and operational risks to recommend corrective actions and sustainable process improvements. Reporting, Communication, and Stakeholder Support Provide regular reports and consultation to management regarding vendor performance, financial performance, operational risks, and remediation progress. Facilitate education and communication for vendors, internal stakeholders, and business partners regarding regulatory changes, vendor processes, compliance expectations, and operational impacts. Cultivate effective working relationships with vendors, internal stakeholders, leadership, and cross-functional teams to support accountability and regulator confidence in organizational performance. Mentor or train team members on assigned processes, documentation standards, tools, and regulatory or vendor-management expectations. 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 other duties as assigned COMPETENCIES REQUIRED COMPETENCIES Required Job Skills Intermediate skill in using standard office equipment, including copiers, scanners, fax machines, and telephones. Intermediate PC proficiency. Intermediate proficiency with spreadsheet, database, presentation, and word-processing software. Required Professional Competencies Advanced knowledge of ethical, corporate, or government compliance requirements or HIPAA privacy requirements. Strong analytical skills that support independent and effective decision-making. Ability to prioritize tasks and manage multiple priorities, including work performed under limited time constraints. Perseverance when facing resistance or setbacks. Effective interpersonal skills and the ability to maintain positive working relationships. Strong verbal and written communication skills. Ability to interact professionally with executives, managers, subject matter experts, and other diverse stakeholders. Ability to create and deliver employee education about complex government, corporate compliance, privacy, and ethical issues in an understandable manner. Ability to maintain confidentiality and protect private information. Ability to generate reports from available data and make informed decisions based on reported results. Required Leadership Competencies Ability to take appropriate, informed risks using available data. Ability to build synergy within a diverse team operating in a changing environment. PREFERRED COMPETENCIES Preferred Job Skills Advanced skill in using standard office equipment, including copiers, scanners, fax machines, and telephones. Advanced PC proficiency. Advanced proficiency with spreadsheet, database, presentation, and word-processing software. Preferred Professional Competencies Expert knowledge of ethical, government, or corporate compliance requirements or HIPAA privacy requirements. Ability to work with ambiguous or conflicting information while remaining focused on the intended outcome. Preferred Leadership Competencies None specified. #LI-AB1 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 . If interested in this position, please apply.