Jobs at Horizon Blue Cross Blue Shield of New Jersey

Manage and retain public-market accounts by handling contract renewals, negotiating terms, selling additional product lines, and developing new business. Provide client workshops on enrollment and claims, advise on regulatory impacts, modify contracts as needed, and make binding financial and service decisions. Requires travel across New Jersey and coordination with stakeholders.

The Data Financial Reporting Analyst manages data supporting revenue and accounts receivable, performs complex financial analysis, and prepares reports for management. They lead junior analysts, ensure accurate month-end activities, support Medicaid revenue reporting, and engage in special projects while maintaining relationships with internal stakeholders.

Lead and supervise a managed long term support and services clinical care team to ensure quality, compliance, and cost containment. Oversee daily operations, coach staff, develop policies and KPIs, coordinate with Medical Directors, manage budgets, support accreditation/regulatory activities, and drive process improvements and service innovations.

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.

Provides transactional and regulatory corporate legal support: draft, negotiate, and review contracts; advise on legal risks; research laws and regulations; liaise with external counsel and regulators; support assigned practice group on business and operational legal matters.

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

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

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

Conduct file audits of clinical operations for regulatory compliance (NCQA, URAC, CMS), analyze and report audit outcomes and error trends, manage CMS-CAPs documentation in SharePoint, administer MCG-IRR testing, perform ad hoc audits, and recommend process improvements and training.

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

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.

Performs RN case management for pediatric members: assesses clinical needs, evaluates appropriateness of care, coordinates and monitors care plans across settings, advocates for members, documents per policy, mentors staff, and supports quality improvement. Clinical Advocate addendum includes member outreach, motivational interviewing, benefits education, and care coordination. Works varied weekday shifts; acts as subject matter expert and participates in committees and system testing.

Lead high-impact strategy projects advising senior leaders at a health payer, design and execute analytics and research, build business cases, manage cross-functional teams and 2-3 analysts, and deliver polished executive presentations and recommendations to drive strategic decisions.

The Quality Management Specialist supports project planning and implementation, analyzes data for quality improvements, manages budgets, and enhances healthcare services through collaboration and performance measurement.

Lead job architecture initiatives and compensation strategies, provide market pricing oversight, mentor junior staff, and support compensation projects across divisions.

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

Lead and manage provider network contracting and negotiations across Commercial, Medicare, Medicaid and value-based lines. Prepare rate proposals with Medical Economics, ensure accurate contract implementation, resolve provider file/claims issues, maintain contract language/templates, analyze contracts for cost savings, and collaborate with Legal, Compliance, and cross-functional teams to execute network strategy and value-based payment initiatives.

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.