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.
The Product Modeler I provides business knowledge and basic technical skills to implement technical solutions, evaluate products and provide technical support to various inter-departmental areas.Job Description Summary:
The Product Modeler I provides business knowledge and basic technical skills to implement technical solutions, evaluate products and provide technical support to various inter-departmental areas.
Responsibilities:
- Creates, tests and implements product data model (Benefit Coding) as assigned.
- Contributes with product modeler projects.
- Resolves technical benefit system issues identified during implementation (testing/QR).
- Research, resolve and respond to benefit system defects as assigned (plogs/audit citations).
- Research, resolve and respond to Enterprise Audits.
- Maintaining acceptable quality and timeliness as outlined by management.
- Communicates issues to Lead Product Modeler in a timely manner.
- Any other tasks as assigned by management.
Disclaimer:
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.
Education/Experience:
- High School Diploma/GED required.
- Requires a minimum of 2-3 years of experience in health insurance or relevant field.
- Requires 2-3 years of benefit product experience
Knowledge:
- Requires both broad and deep product and business knowledge.
- Prefers NASCO system knowledge.
- Prefers claims knowledge.
- Prefers medical policy knowledge.
- Prefers knowledge of Excel.
- Prefers knowledge in state and federal mandates.
- Heavily relies on instructions and pre-established guidelines to perform job functions.
Skills and Abilities:
- Requires the ability to learn design solutions by mapping common product requirements and business problems to reusable end-to-end technology solutions.
- Requires proven ability in the following:
- Communication Skills
- Analytical Thinking
- Time Management
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Salary Range:
$62,100 - $83,160This 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:
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.
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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.
