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This role involves negotiating contracts for network providers in the Workers' Compensation Managed Care sector, ensuring compliance with regulations, preparing financial proposals, and collaborating with various departments to implement and maintain contracts effectively.
The Risk Adjustment Data Analyst III is responsible for overseeing risk adjustment data submission and validation, performing analysis and reporting for risk score calculations and audits, developing predictive models, coaching junior analysts, and conducting data collection and validation. The role also involves producing reports and managing policy documentation related to risk adjustment processes.
The Paralegal I provides legal support for litigation at Horizon BCBSNJ, including maintaining legal documents, conducting research, coordinating document collections, and assisting attorneys with case management. Responsibilities also include drafting correspondence, handling subpoenas, and ensuring compliance with relevant legislation.
Lead the design, implementation, and monitoring of HEDIS member and provider interventions, oversee key initiatives, analyze data, interact with stakeholders, and support strategic planning of HEDIS activities in a healthcare setting.
The Financial/Accounting Analyst II will be responsible for financial planning and analysis, accounting activities, and reporting. They will work with various divisions and leadership teams to support budgeting, forecasting, and general ledger closing activities. Responsibilities also include handling special projects, conducting financial analysis, ensuring compliance, and preparing managerial reports.
The Enterprise Architect is responsible for developing and maintaining enterprise architecture deliverables, guiding IT strategy, integrating solutions across organizational systems, monitoring performance, and providing technical leadership while ensuring compliance with architecture principles.
The Sr. Data Capture Operator is responsible for high-speed scanning of documents, ensuring proper processing procedures, and maintaining equipment in a production environment. The role involves resolving technical issues and performing related tasks as required.
The Systems Auditor III oversees and executes IT audit work programs, plans audits on complex IT processes, documents audit results, identifies control issues, and provides feedback on auditor performance. The role involves coordinating with management, external auditing firms, and training less-experienced auditors, while ensuring audit compliance and recommending improvements.
The Auditor III role involves supervising and executing audits, developing and documenting control issues, preparing reports on internal controls, and building relationships with management. It requires quality oversight of audit tasks and guidance for staff, alongside developing expertise in business risks and industry practices.
The Analytics Analyst III is responsible for providing complex resolutions to analytics and data problems, managing data preparation, analysis, and interpretation to deliver actionable insights and recommendations to various senior stakeholders. This role involves developing advanced analytic models, performing data mining, and fostering continuous improvement through performance data analysis and consultation.
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