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Remote Highmark Blue Shield Jobs (NOW HIRING)

Ria Health

Licensed Psychologist- (PSYPACT) Remote

Tampa, FL · Remote

  • Medical

  • Dental

  • Vision

  • PTO

... Blue Shield, UnitedHealth Group Optum, Beacon Health Options, Highmark Health, and Magellan Health. ROLE OVERVIEW Ria Health is seeking a full-time Licensed Psychologist with PSYPACT authority (or ...

Ria Health

Licensed Psychologist- (PSYPACT) Remote

  • Medical

  • Dental

  • Vision

  • PTO

... Blue Shield, UnitedHealth Group Optum, Beacon Health Options, Highmark Health, and Magellan Health. ROLE OVERVIEW Ria Health is seeking a full-time Licensed Psychologist with PSYPACT authority (or ...

Minnesota Jobs

Remote Member Experience Advocate

$25.25 - $28.54/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Member Experience Advocate At Blue Cross and Blue Shield of Minnesota, we are committed to paving ... CST 100% remote, work-from-home position High-speed, land-based internet service is required ...

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Remote Highmark Blue Shield information

What does a remote Highmark Blue Shield employee do?

A Remote Highmark Blue Shield employee typically works from a location outside of the company’s physical offices, providing services such as customer support, claims processing, case management, or administrative duties for Highmark Blue Shield, a major health insurance provider. These roles are focused on supporting members, resolving inquiries, processing insurance claims, and ensuring quality care management. Remote employees use digital tools and secure platforms to communicate, manage data, and collaborate with their teams while maintaining confidentiality and compliance with healthcare regulations.

What are the key skills and qualifications needed to thrive as a remote Highmark Blue Shield customer service representative?

To thrive as a Remote Highmark Blue Shield Customer Service Representative, you need strong communication skills, knowledge of health insurance products, and at least a high school diploma or equivalent. Familiarity with customer relationship management (CRM) systems, call center software, and basic computer applications is typically required. Excellent problem-solving abilities, patience, and professionalism help you excel in assisting members and resolving their concerns. These skills ensure efficient service delivery, accurate information, and positive customer experiences while working remotely.

How does working remotely for Highmark Blue Shield impact day-to-day collaboration with colleagues and supervisors?

Working remotely at Highmark Blue Shield often involves using digital communication tools such as Microsoft Teams, Zoom, and email to stay connected with your team and supervisors. You will likely participate in virtual meetings, regular check-ins, and collaborative projects, ensuring alignment with company goals and team objectives. While remote work offers flexibility, it also requires proactive communication and strong time-management skills to stay productive and engaged. Many remote employees find that they can effectively collaborate and build relationships through these virtual channels, though it may take some adjustment compared to in-person interactions.
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Infographic showing various Remote Highmark Blue Shield job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Initial Clinical Reviewer - Remote - AZ

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 9 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

290th of 308 rated insurance

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
  • Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry.

QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
  • 2 years of experience in clinical field of practice, health insurance, or other health care related field

Required Education
  • Associate's Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
Required Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN.

Required Certifications
  • N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 3 years of experience in clinical field of practice, health insurance, or other health care related field
Preferred Education
  • Bachelor's Degree in Nursing or related field of study
Preferred Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
Preferred Certifications
  • N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

  • Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Maintain complete and accurate records per department policy.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
  • Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
  • Demonstrate ability to apply plan policies and procedures effectively.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
  • When indicated to assist with team/project functions:
    • Collaborate with team to distribute workload/work tasks;
    • Monitor and report team tasks;
    • Communicate team issues and opportunities for improvement to supervisor/manager;
    • Support/mentor team members.
  • Participate in continuing education and current developments in the fields of medicine and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • The position has an onsite expectation of 0 days 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
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Strong current clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities
  • Independent and sound judgment with good problem solving skills

Required Leadership Experience and Competencies
  • Resolve conflicts
  • Represent BCBSAZ in the community

PREFERRED COMPETENCIES
Preferred Job Skills
  • Advanced PC proficiency
  • Knowledge of CPT-4 and ICD-9 coding

Preferred Professional Competencies
  • Knowledge of managed care, utilization management, and quality management
  • Working knowledge of McKesson InterQual® criteria

Preferred Leadership Experience and Competencies
  • N/A

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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