Search the 25 jobs at Horizon Blue Cross Blue Shield of New Jersey

The Manager Strategic Initiatives II leads strategy consulting projects for Horizon BCBSNJ, providing thought leadership and managing multiple complex projects. Responsibilities include developing work plans, conducting research and analytics, guiding teams, and communicating findings to senior stakeholders.

This role involves negotiating contracts for network providers in the Workers' Compensation Managed Care sector, ensuring compliance with regulations, preparing financial proposals, and collaborating with various departments to implement and maintain contracts effectively.

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.

The Privacy Associate is responsible for ensuring compliance with privacy laws and regulations, investigating non-compliance complaints, developing privacy policies, performing risk assessments, and providing training on privacy standards. The role involves collaborating with various business areas and maintaining reports on the Privacy Compliance Program.

The Enterprise Architect is responsible for developing and maintaining enterprise architecture deliverables, guiding IT strategy, integrating solutions across organizational systems, monitoring performance, and providing technical leadership while ensuring compliance with architecture principles.

The Sr. Data Capture Operator is responsible for high-speed scanning of documents, ensuring proper processing procedures, and maintaining equipment in a production environment. The role involves resolving technical issues and performing related tasks as required.

The Systems Auditor III oversees and executes IT audit work programs, plans audits on complex IT processes, documents audit results, identifies control issues, and provides feedback on auditor performance. The role involves coordinating with management, external auditing firms, and training less-experienced auditors, while ensuring audit compliance and recommending improvements.

The Auditor III role involves supervising and executing audits, developing and documenting control issues, preparing reports on internal controls, and building relationships with management. It requires quality oversight of audit tasks and guidance for staff, alongside developing expertise in business risks and industry practices.

The Financial/Accounting Analyst II will assist the Corporate Finance department with financial planning, analysis, and accounting responsibilities, engaging in activities like financial reporting, ledger closing, variance analysis, and compliance to support management decisions across various divisions.

The Network Data Analyst I is responsible for assigning and maintaining standard network rates, performing root cause analysis for appeals and rate issues, and documenting system problems while recommending solutions. The role includes analyzing CPT codes, updating system files, conducting quality audits, and executing other assigned duties.

The Cloud Architect at Horizon BCBSNJ is responsible for managing the cloud computing system and developing strategies for cloud applications. Key responsibilities include designing cloud architecture, ensuring data transfer efficiency, maintaining security, and collaborating with teams on cloud usage and data policy standards. The role requires handling technical issues and staying updated on cloud technologies, and also involves engagement with marketing and enterprise architecture teams.

The Analytics Analyst III is responsible for providing complex resolutions to analytics and data problems, managing data preparation, analysis, and interpretation to deliver actionable insights and recommendations to various senior stakeholders. This role involves developing advanced analytic models, performing data mining, and fostering continuous improvement through performance data analysis and consultation.

The Provider Engagement Specialist develops strategic plans and engages with providers to enhance performance in Risk Adjustment. Responsibilities include monitoring provider behavior, improving medical record documentation, and fostering relationships to support educational initiatives on coding and documentation practices.

The Accounts Receivable Financial/Accounting Analyst II prepares and analyzes financial reports, manages AR collections, applies cash receipts, supports audits, and undertakes special projects. The role requires working independently on monthly closings and variance analysis, while fostering business partnerships for successful financial oversight.

The UM Appeals Analyst acts as a liaison among members, physicians, and operational business members, overseeing appeals processes, preparing cases, mentoring staff, and managing communications. Responsibilities include reviewing service requests, interacting with Medical Directors, and conducting root cause analysis to improve appeal handling.

The Sr. Director of Growth & Retention at NovaWell is responsible for achieving strategic financial goals, securing revenues, and managing customer success. This role includes developing sales strategies, overseeing contract negotiations, and ensuring effective marketing and communications. The position also entails maintaining relationships with high-level clients and decision-makers while managing an account management team.

The Analytics Analyst II will provide complex resolutions to analytics problems by gathering data, delivering reporting/analysis, and collaborating with customers. They will produce and present actionable insights and ensure compliance with data integrity and reporting standards.

The Enterprise Architect leads the development of enterprise solution architecture, ensuring alignment with business objectives and governance of project outcomes. Responsibilities include defining solution portfolios, developing road maps, harmonizing systems with architecture, and guiding teams through solution design and implementation.

The Segmentation Analyst is responsible for analyzing market share and segmentation to support marketing campaigns and business performance. They will leverage data sources to identify target audiences and optimize marketing strategies across multiple channels. Additional responsibilities include developing predictive models and translating data into strategic reports for business leadership.

The UM Appeals Analyst supports Health Services and Utilization Management by reviewing service requests, managing appeal correspondence, presenting cases at appeals committees, and mentoring junior staff. Responsibilities include data collection, customer interaction, scheduling discussions with Medical Directors, and root cause analysis for appeal occurrences.