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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.
Responsible for conducting research and root cause analysis for customers (internal/external) with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situations.
Responsibilities:
Investigate issues to identify root cause of issues; identify and communicate business needs assessments as necessary. Develop forecasting tools using current technology/systems (Salesforce Access, Excel, Monarch, Cyberark, etc.) Translate business requirements and assist IT with the development of technical specifications. Develop solutions based on data analysis to increase business efficiency. Partner with internal stakeholders for business solutions and best practices (Sales, Underwriting, Analytics, Finance, Billing, HNS, etc.) Lead or 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; review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective action steps. May coach/mentor less experienced staff, assist in on-boarding of new staff and/or distribute and follow-up on work assignments. Perform other relevant tasks as assigned by management. Responsible for using multiple data sets to create reports, conduct analysis and research, identify trends and assist with the forecasting of products. Create databases, interactive reports and queries from multiple sources to provide reporting for various teams and leadership. Conducts root cause analysis and partner with IT to implement solutions and monitor results to completion. Partner with external vendors to reduce errors from billing reports to create efficiencies, reduce cost, and improve quality. Reconcile vendor transactions billed in comparison to source systems. Ensure vendors are billed based on contractual obligations. Identify areas of opportunity with vendor billing and transactions and make recommendations to leadership. Ensure vendors are meeting contractual obligations. Identify areas of opportunity with vendor billing and transactions and make recommendations to leadership. Create databases, monitor forecasting, summarize findings, and make recommendations for improvement.
Education/Experience:
High School Diploma/GED required. Bachelor degree preferred or relevant experience in lieu of degree. Minimum of seven (7) years' experience in an operational role, or analytical role. Data Analytics experience preferred
Knowledge:
Knowledge of Healthcare industry required. Knowledge of (Excel, SQL, SAS or Tableau) Knowledge of Project Management methodologies. - Knowledge of Stop Loss or Reinsurance preferred
May require knowledge of Horizon Blue Cross Blue Shields products and services. May require working knowledge of division operating plan and Horizon operating model.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Salary Range: $86,000 - $117,390
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:
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.
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Horizon Blue Cross Blue Shield of New Jersey
tuition reimbursement
Jun 13, 2025