Horizon Blue Cross Blue Shield of New Jersey

Compensation

Full Description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. Under general supervision conducts research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is an intermediate level position and may require guidance. Responsibilities: Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary. May create forecasting tools using current technology/systems (Access, Excel, Monarch, etc.) May translate business requirements and assist IT with the development of technical specifications. Recommend solutions based on data analysis to increase business efficiency and/or improve existing processes. Participate in internal and external project workgroup(s) and presentations. Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc. Prepare materials for internal and external audit activities; may review audit findings/reports for accuracy and completeness. Perform other relevant tasks as assigned by management. ADDENDUM FOR OON MANDATE STATE NEGOTIATIONS/ARBITRATION TEAM ANALYSTS: Support in developing or drafting Business Requirement documents and identifying process gaps that require the creation or revision of workflows Collaborate with Compliance, Legal and the Business Process Improvement teams on special projects to mitigate compliance risks Identify eligible surprise bill services and coordinate correct cost sharing in claims system Acts as a Liaison with external vendors to create operational efficiencies, reduce cost, and improve quality Building of data extracts/reports to monitor surprise billing activity (e.g., number of disputes, provider trending, win/loss, etc.) Perform root cause analysis to identify non-compliance trends and potential fraud, enabling cost saving opportunities Education/Experience: High School Diploma/GED required. Minimum of four (4) years' experience in an operational role, or analytical role. Knowledge: Knowledge of Healthcare industry preferred. Strong Computer Skills-Microsoft Office products to include (Access, Word, Excel, PowerPoint, Project, Visio, etc.). Team Player, Strong Analytical and Interpersonal Skills. Travel: Some travel may be required. Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Salary Range: $70,500 - $94,395 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: Comprehensive health benefits (Medical/Dental/Vision) Retirement Plans Generous PTO Incentive Plans Wellness Programs Paid Volunteer Time Off Tuition Reimbursement Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job. Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process. About Us We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too. Our Mission We empower our members to achieve their best health. Our Vision We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.