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,