Offer summary

Qualifications:

High School Diploma/GED required; Bachelor's degree preferred or relevant experience in lieu of degree., Minimum of seven years' experience in an operational or analytical role., Knowledge of the healthcare industry and project management methodologies is required., Proficiency in Excel is strongly preferred..

Key responsabilities:

Investigate service-related issues to identify root causes and communicate business needs assessments.

Develop forecasting tools and translate business requirements for IT technical specifications.

Lead internal and external project workgroups and conduct User Acceptance Testing (UAT).

Prepare materials for audits and coach/mentor less experienced staff as needed.

Job description

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.

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situations.

Responsibilities:

Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary.
Develop forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)
Translate business requirements and assist IT with the development of technical specifications.
Develop solutions based on data analysis to increase business efficiency.
Lead or participate in internal and external project workgroup(s) and presentations.
Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
Prepare materials for internal and external audit activities; review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective action steps.
May coach/mentor less experienced staff, assist in on-boarding of new staff and/or distribute and follow-up on work assignments.
Perform other relevant tasks as assigned by management.

ADDENDUM FOR QUALITY AUDIT MEASUREMENT TEAM ANALYSTS:

Identifies process improvement opportunities for platform work as an example, review SQM and QA reports, review trends to identify process improvement and automation)
Gather, process FCR and QA performance data and conduct trending and root cause analyses
Design and develop standard reports for metrics reporting and analysis. Document call center processes using standard techniques.

Education/Experience:

High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Minimum of seven (7) years' experience in an operational role, or analytical role.

Knowledge:

Knowledge of Healthcare industry required.
Knowledge of Project Management methodologies.
May require knowledge of Horizon Blue Cross Blue Shields products and services.
May require working knowledge of division operating plan and Horizon operating model.
Excel Proficiency strongly preferred

Travel:

Some travel may be required.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$86,000 - $117,390

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:
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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