Jobs at Horizon Blue Cross Blue Shield of New Jersey

Lead and supervise assigned internal audits and initiatives: develop scope and work programs, perform testing and analysis, document control issues, prepare reports, track remediation, and mentor staff while collaborating with management to improve internal controls.

Draft, review, negotiate, and manage commercial, vendor, finance, real estate, and Business Associate Agreements. Develop templates and contract tools, advise stakeholders on legal risks, train colleagues on contract best practices, report on BAA performance, support privacy incident response and data ethics, and recommend operational efficiencies.

Performs behavioral health utilization and care management: assesses clinical needs, ensures appropriate level/length of stay, coordinates transition and services across providers, documents care, monitors outcomes, and advocates for members to optimize cost-effective care.

The National Programs Analyst coordinates Association initiatives, ensures compliance, resolves issues impacting claims, and collaborates with IT for systemic solutions.

Manage and support national accounts by selling and expanding business, delivering client presentations, analyzing data for cost-saving plan designs, resolving complex service issues, facilitating enrollments and implementations, maintaining account data, and building internal and external relationships.

The Sales Executive IV drives new account sales across various markets, focusing on meeting sales targets and building relationships with clients and brokers.

The CPC Investigator conducts coding reviews, audits medical records, analyzes claims for fraud, and manages investigative activities related to healthcare operations.

Supervise and execute audits, ensuring quality and effectiveness of internal controls, while managing staff and providing strategic recommendations to management.

The Medical Director oversees provider education and performance management initiatives, cultivating relationships to support quality outcomes and value-based care goals, while leading a team and refining strategies for collaboration and care delivery innovation.

The Paralegal III provides litigation and transactional support, conducts legal research, prepares documents, and collaborates with attorneys and departments.

Support actuarial decision-making through trend analysis, forecasting, and modeling for ACA, Medicare Advantage, and Medicaid. Perform risk score projections (CMS-HCC, HHS-HCC), financial and utilization reporting, vendor performance analysis, and support pricing, rate filings, and MA bid submissions.

Performs utilization management RN duties: assess medical necessity and appropriateness of care, coordinate member care across settings, implement care plans, document outcomes, communicate with multidisciplinary teams, and support cost‑effective, quality care transitions. Requires periodic weekend/holiday coverage.

Performs utilization management RN duties: assesses clinical need against guidelines, evaluates medical necessity and efficiency, coordinates care transitions, monitors services and outcomes, documents per standards, communicates with multidisciplinary teams, advocates for members, and participates in quality improvement and case/disease management.

Lead sales enablement and customer/broker marketing for multiple business segments, develop go-to-market and open enrollment strategies, manage budgets and reporting, coordinate with enterprise marketing on creative and KPIs, run advisory board and event presence, maintain broker-facing content and sales assets, and support cross-functional execution to meet membership and revenue goals.

Investigate, research, and resolve member and provider complaints using the IMAC database. Ensure state timing and compliance, compile monthly/quarterly reports, follow up with internal teams, and draft resolution letters. Support monthly reporting and other duties as assigned.

Responsible for assessing patients' clinical needs, coordinating care, and ensuring appropriate services while advocating for members in the healthcare continuum.

The Digital Products Reporting Manager will lead and develop reporting and analytics strategies for digital products, present insights to stakeholders, and analyze performance and trends to enhance user experiences and project outcomes.

Serve as BCM subject matter expert to configure Fusion tool, develop recovery strategies, maintain BCM plans, run Business Impact Analyses, lead training/exercises, support incident response, and report to senior management.

Provide RN case management for pediatric members: assess clinical needs, develop and coordinate individualized care plans, manage transitions across the continuum, monitor outcomes, collaborate with providers and families, document per policy, close gaps in care, and mentor/train staff.

Lead enterprise change management and organizational readiness for operational and technology transformations. Develop and execute change strategies, stakeholder engagement and communication plans, readiness assessments, release planning, risk mitigation, governance support, adoption measurement, and continuous improvement to ensure successful implementation and sustainable adoption.