Job Summary:

This job is responsible for managing, monitoring, documenting and resolving operational issues associated with the business relationships of Horizon and its delegates. In addition, this position is responsible for planning, coordinating and/or implementing various projects/initiatives associated with the delegates.Responsibilities:

Acts as the primary liaison between Horizon and subcontractors to address day to day operational issues.

Coordinates activities of various DVOD resources and other Horizon resources, which require expansive knowledge of health insurance, managed care and claims.

Facilitates meetings to drive issue resolution and project/process improvements.

Responsible for education, implementation and monitoring of subcontractors for service delivery and adherence to Horizon business requirements.

Assist with the implementation of new programs and company initiatives, which includes coordinating, documenting and communicating information as appropriate.

Analyzes contractual requirements, identifies contract deficiencies and recommends changes.

Participates on audit teams to measure delegate regulatory compliance, contractual performance measures, and Horizon guidelines with respect to claims payment.

Compiles compliance audit performance reports of delegates and communicates audit findings, recommendations, and trends to senior management via reports and/or presentations.

Acts as technical expert and reference point for difficult and complex matters.

Participates in special projects initiated by the Plan.

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

Bachelor degree preferred or relevant experience in lieu of degree

Requires a minimum of 5 years of experience in the healthcare industry preferably in compliance

Knowledge:

Requires familiarity with contracting concepts.

Requires knowledge of the regulatory environment, state specific laws, mandates and regulations.

Requires knowledge of Horizon BCBSNJ's operations and products.

Prefers knowledge of auditing procedures.

Requires knowledge of managed care and health insurance industry.

Skills and Abilities:

Requires excellent organizational and leadership skills.

Requires excellent oral and written communication skills.

Requires excellent problem solving skills.

Requires excellent presentation skills.

Requires management skills.

Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.

Requires strong project management skills.

Requires excellent interpersonal and communications skills.

Requires strong analytical skills.

Requires strong communication skills.

Salary Range:

$94,900 - $129,570

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

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.