Teams at Horizon Blue Cross Blue Shield of New Jersey

Performs RN case management using clinical guidelines to ensure appropriate care levels, coordinates member care across settings, advocates for members, documents care, mentors new RNs, and serves as SME on projects and user acceptance testing. Focuses on whole-person advocacy and member engagement through outreach and motivational interviewing.

Support premium rate development and pricing for large group, individual, and small group markets. Perform pricing analyses, financial modeling, experience studies, regulatory and Mental Health Parity reviews, and rate filings. Collaborate with actuarial, product, finance, and regulatory teams to analyze data, assess legislative impacts, and produce reports and recommendations to support pricing strategy and regulatory compliance.

Perform advanced actuarial analyses, forecasting, pricing, and financial modeling using claims, membership, and utilization data. Develop reports and dashboards, support IBNR estimates, rate development, regulatory filings, and product pricing. Collaborate with business partners, present findings, and continue actuarial exam progression.