Supv, Out of Network Mandate

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 is responsible for providing oversight for the State and Federal Out of Network (OON) Mandate program(s). The position supports the development and implementation of standards, systems, policies, and procedures in alignment with organizational strategic initiatives, ensuring compliance with all State, Federal and Association mandates pertaining to out of network payment rules (i.e. Out of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (OON Mandate).

What You'll Do

Job Responsibilities:

• Supervises, analyzes and coordinates the work of the business team to ensure that quality and productivity goals are met.
• Provides help, guidance, training, technical training and instructions to staff so that team members can improve their performance and broaden their skill sets. When necessary, performs the operational duties of the business team members.
• Ensures an atmosphere within the business team which fosters open communication, teamwork, participation, ownership, and empowerment to make decisions.
• Evaluates the performance of the business team as a whole and of the individual members of the team.
• Ensures that the customer is satisfied with the level of service provided.
• Acts as technical expert and reference point for difficult and complex matters.
• Facilitates the creation of service and processing innovations within the team. Shares innovations with other teams and market divisions.
• Monitors and reports on key performance indicators to team members and to upper management.
• Assists in preparing and monitoring the budget to ensure administrative cost objectives are met. Identifies and implements cost saving/revenue generating opportunities.
• Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects.
• Interprets and executes and modifies policies for the business team.
• Participates in special projects initiated by the Plan.
• Represents the Plan with external customers, providers and external agencies.
• Develop/Update enterprise-wide training material related to OON Mandate Surprise Billing handling.
• Represent Surprise billing functions on divisional and enterprise work groups. May be responsible to lead some such groups.

Supervisory Accountability Statement:
Maintains a motivated and productive staff by providing sound leadership and direction; models appropriate behavior; renders timely decisions; provides coaching, feedback and recognition; conducts appropriate and timely performance appraisals; selects the best qualified candidates to fill job vacancies; administers company policies fairly; provides for development activities and opportunities to assure the application and assessment of skills learned.

Measures may include:

• Observation
• Review of PM Plans/Appraisals
• Solicited and unsolicited staff feedback
• Employee satisfaction results
• Report on late Performance Appraisals
• Additionally, the incumbent in this position is responsible for managing departmental administration expenses, including salary and non-salary costs, within the established budgetary constraints.

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What You Bring

Education/Experience:

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of three to five years experience in a professional business environment.
• Prefer three to five years experience as a supervisor.
• Prefer three to five years experience in the health insurance industry.

Knowledge:

• Requires three to five years experience medical claims processing.
• Require of extensive knowledge of computers and software relative to the business and extensive knowledge of functional tasks performed within the team.
• Require general knowledge of tasks performed by areas that support the business team.
• Require knowledge of medical and/or health insurance industry.

Skills and Abilities:

• Require the ability to express thought clearly and concisely both orally and in writing.
• Require the ability to obtain the skills possessed by the team members and to demonstrate technical competence on systems used.
• Require the ability to effectively lead team members in diversified tasks.
• Requires excellent organizational skills.
• Requires excellent presentation skills.
• Requires the ability to think analytically and to report findings in a accurate manner.

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:

$87,300 - $119,070

​This 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.