Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
About the Role
This position will lead the coordination of analytics and process functions within the Enterprise Risk Adjustment department and will work with functional leaders to gather input and improve processes in order to achieve organizational objectives. The Risk Adjustment Operations Manager will provide reporting and business insights, generating presentation materials for external groups, and support ad-hoc or special projects. This role will work with divisional and business unit leaders across the enterprise to facilitate and manage risk adjustment alignment activities for those departments.What You'll Do
- Gather and organize status of operational activities across the risk adjustment department.
- Participate in or lead internal or external project workgroup(s) and presentations.
- Provider regular reporting on the status of operations and analytics functions and provide actionable insight to department and enterprise leadership.
- Author presentation materials including necessary research for external and leadership audiences for department leadership.
- Request analytics and reporting to support decision making related to alignment of Horizon business units to risk adjustment.
- Meet with business unit and divisional leaders across Horizon to define the problem or opportunity, collaborate on solution design, and manage the implementation of alignment solutions related to product development, network design, and pricing practices.
- Present various risk adjustment materials or status to Horizon leadership.
- Escalate issues or other departmental problems and track them to resolution.
- Support management through ad hoc reporting and special projects.
- Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
What You Bring
Education/Experience:
- Bachelor degree preferred or relevant experience in lieu of degree.
- Minimum of six (6) years’ experience with at least four (4) years’ experience in a project support or analysis role.
- Requires people management experience.
Knowledge:
- Detailed knowledge of risk adjustment and health plan operations.
- Knowledge of project management methodologies.
- Knowledge of the creation and management of insurance products, network contracting and design, healthcare management programs, actuarial pricing practices, and analytics functions and techniques.
Why Horizon?
At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!
Salary Range:
$97,800 - $133,455This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Disclaimer:
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Skills Required
- Bachelor's degree or relevant experience in lieu of degree
- At least six years of experience
- At least four years of experience in a project support or analysis role
- People management experience
- Detailed knowledge of risk adjustment and health plan operations
- Knowledge of project management methodologies
- Knowledge of insurance product creation and management, network contracting and design, healthcare management programs, actuarial pricing practices, and analytics functions and techniques
Horizon Blue Cross Blue Shield of New Jersey Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Horizon Blue Cross Blue Shield of New Jersey and has not been reviewed or approved by Horizon Blue Cross Blue Shield of New Jersey.
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Leave & Time Off Breadth — PTO is characterized as generous, with ample days off and holidays enhancing the overall package. This breadth of time away supports a favorable view of total rewards.
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Flexible Benefits — Remote and hybrid options are available in multiple functions and are cited as a meaningful perk. Flexibility in where work is performed contributes to overall satisfaction with rewards.
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Retirement Support — The 401(k) match is considered decent to good. Retirement offerings are viewed as a solid component of the total package.
Horizon Blue Cross Blue Shield of New Jersey Insights
What We Do
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company. Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ. Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
