Teams at Horizon Blue Cross Blue Shield of New Jersey

Leads enterprise business process improvement initiatives focused on cost reduction, efficiency, and customer experience. Uses Lean, DMAIC, Design for Six Sigma, value-stream mapping, statistical analysis, ROI modeling, and control plans. Oversees analyses, mentors Lean and Green Belt candidates, manages project risks and deliverables, develops business cases, and collaborates with business partners and subject matter experts to deliver sustainable operational and financial improvements.

Conduct medical appeals and utilization management reviews, ensuring regulatory compliance and timeliness. Review medical records, coordinate with Medical Directors, IURO/IRO and legal as needed, present cases to appeals committees, mentor appeals staff, provide on-call coverage, and support quality improvement and vendor/delegate oversight.

Interprets, documents, and validates group health benefit information for new and existing clients. Reviews benefit designs, coordinates internal implementation and coding, confirms system testing, maintains audit records, troubleshoots enrollment, claims, and billing issues, and supports client meetings, enrollment sessions, training, and pre-implementation audits. Builds relationships with account management and internal teams to implement benefit changes and new lines of business.