Search the 27 jobs at Horizon Blue Cross Blue Shield of New Jersey

The Mgr, IVR Product Management is responsible for the strategic direction, performance, and return on investment of IVR platforms, enhancing customer experience and optimizing operations. The role involves collaboration with cross-functional teams, implementation of IVR enhancements, development of reporting solutions, and ensuring compliance with industry standards.

The Risk Adjustment Data Analyst III is accountable for the submission and validation of risk adjustment data, conducting analysis and reporting for risk score calculations, overseeing data quality and compliance with regulatory standards, and collaborating with stakeholders. The role also involves coaching junior analysts and supporting audits.

The Risk Adjustment Data Analyst III is responsible for overseeing and contributing to the submission and validation of Risk Adjustment Data, performing analysis, documenting errors, creating predictive models, and mentoring junior analysts. The role requires strong analytical skills and involves collaboration with various stakeholders to ensure compliance with regulatory guidelines.

The Quality Improvement Data Analyst is responsible for analyzing reporting needs, developing reporting capabilities, and providing analytical support for the department. The role involves conducting complex analytics, translating business requirements, leading project workgroups, and mentoring junior staff while ensuring timely production of reports and conducting research on healthcare data.

The HEDIS Quality Auditor II-FEP conducts quarterly and ad hoc file audits to ensure compliance with regulatory standards. Responsible for documentation and analysis of audit outcomes, communication of results, and recommendations for process improvements. Manages CMS-CAPs audits and supports testing procedures while maintaining databases for audit results.

The Associate Utilization Analyst reviews medical documentation and claims to ensure compliance with clinical guidelines. Responsibilities include clinical reviews, preparing cases for review, and responding to inquiries from the Claims Policy teams. The role requires collaboration with claims policy analysts to ensure proper claims adjudication.

The Quality Improvement Data Analyst focuses on enhancing quality through data research, analysis, and reporting. Responsibilities include developing production reporting capabilities, providing statistical support, facilitating analytic projects, conducting user testing, preparing for audits, and mentoring junior staff to improve operational processes.

The Actuarial Analyst II will perform data-driven analyses to assess risks, conduct gap analysis, support trend analysis, and create solutions for risk capture in the Medicare sector. Responsibilities include presenting results to leadership, collaborating with finance teams, and executing complex actuarial analyses.

The Actuarial Analyst II role involves performing in-depth analysis and data mining to ensure accurate claims and encounter data. Responsibilities include risk adjustment studies, gap analysis, trend analysis of diagnostic coding, and collaborating with various departments to develop data-driven solutions. The analyst will also present findings to leadership and carry out vendor ROI analyses.

The Network Contractor for Horizon Casualty Services will negotiate contracts with health providers, ensure compliance with regulations, and support organizational objectives. The role includes accurate contract implementation, collaboration with internal teams, and assisting in developing contracting strategies in the Workers’ Compensation and Personal Injury Protection sectors.

The Treasury Analyst III is responsible for cash management activities, liquidity projections, treasury operations, managing bank relationships, cash accounting, and ensuring compliance with Treasury guidelines. The role includes analyzing bank fees, forecasting cash needs, leading verification processes for payment transmissions, and driving improvements in cash management operations.

The Enterprise Architect is responsible for developing enterprise architectural deliverables, guiding project teams, analyzing technology integration requirements, and advising management on advanced technical solutions. The role entails maintaining architectural standards, conducting technology reviews, and leading cross-functional teams while ensuring compliance with laws and regulations.

The Salesforce Segmentation Analyst is responsible for analyzing market share and performance, managing data quality, executing marketing strategies across channels, and consulting stakeholders on data analysis. They enhance customer relationship management strategies and develop predictive models to optimize audience targeting and marketing initiatives.

The Network Contracting Account Specialist will negotiate contracts with health care providers, ensuring implementation aligns with Horizon’s budget and compliance standards, while analyzing contracts for cost savings. Collaborating with multiple departments, the role focuses on improving payment models and maintaining provider relationships.

The Analytics Analyst II will utilize statistical tools and data analysis to address complex analytical problems within the healthcare sector, delivering reports and insights while collaborating with various teams. Responsibilities include conducting quantitative analyses, simplifying data, creating actionable insights, and ensuring compliance with data integrity standards.

The Risk Adjustment Data Analyst III is responsible for monitoring and contributing to the Risk Adjustment Data Submission process, collaborating with stakeholders, analyzing risk score data, performing root cause analysis, and supporting the onboarding of junior analysts. The role includes oversight of project timelines, documentation, and process improvements while remaining updated on industry regulations.

This position involves analyzing and designing reporting systems, managing ad hoc reporting requests, and ensuring data integrity in support of departmental needs. The role leverages statistical and analytical skills to produce timely and accurate reports for compliance and operational effectiveness while providing ongoing training and support to staff.

The Tax Analyst I assists in ensuring compliance with federal, state, and local tax laws. Responsibilities include calculating tax provisions, preparing tax disclosures, filing tax returns, and aiding in tax audits, while ensuring adherence to the Sarbanes-Oxley Act.

The Team Leader oversees daily staff management and customer service delivery. Responsibilities include evaluating staff performance, allocating work assignments, monitoring expenses, and ensuring customer satisfaction through business partnerships. The role may involve mentoring and leading multiple work teams, as well as participating in departmental projects as assigned.

The Enterprise Architect leads the development of enterprise solution architecture, manages solution portfolios, collaborates with various teams to ensure alignment with business objectives, and oversees governance compliance. Responsibilities include guiding the design of technical solutions, documenting architecture frameworks, and communicating project requirements effectively.