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.
This position is responsible for the appropriate handling of cases by effectively communicating with employers, claimants, medical providers, attorneys, insurance agents or brokers, and all other involved parties to the claim. This position will be responsible for ensuring all regulatory and organizational requirements are met as well as gather information required to settle a case.
Responsibilities:
Support Horizon Legal staff with cases (ex: Third Party Liability claims, Medical Malpractice claims, Workers Compensation Claims, Class Action Lawsuits, etc.) where Horizon has been impleaded.
Respond to weekly requests from vendor (ex: Summary Plan Documents, Claim Purge Request, Form 5500, etc.).
Audit reimbursement reports to resolve issues and create and submit appropriate reports for management review.
Prepare materials and documentation to assist with internal and external audits as requested.
Review and update group language documents to include the appropriate reimbursement rights and create training materials to support procedural changes.
Assist in monitoring and testing system changes to ensure accuracy.
Mentor junior and temporary staff through coaching and training. Participate in meetings and workgroups as necessary.
Perform other duties as requested by Management.
Education/Experience:
High School Diploma/GED required.
Requires a minimum of four (4) years of experience in claims processing.
Third Party Liability experience preferred.
Knowledge:
Skills and Abilities:
Requires strong computer and reporting skills
Requires strong analytical and problem solving skills
Requires strong verbal and written communication skills
Requires multitasking, follow up, and time management skills
Requires strong interpersonal skills and the ability to mentor junior staff
Requires conflict and relationship management skills
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Salary Range:
$55,400 - $74,130
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:
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.
