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Risk Adjustment Data Analyst IV
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The Data Analyst leads the technology process for the end to end Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data flow and works within key regulator guidelines for acceptable data submission. Using SQL and SAS programs lead the gathering of data for submissions Risk Adjustment. As the senior analyst of data, will be responsible fo
Email Job
Posted Today
Identity & Access Management Engineer-2
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The Identity and Access Management (IAM) Engineer will collaborate cross functionally with Security Architects, Senior Infrastructure Analysts, and Senior Application Developers to provide a stable WAM environment by applying new and best practices in Identity and Access Management and Customer IAM technologies to support business applications. This position will be respo
Email Job
Posted Today
Medicare Analyst
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
This position is responsible for the ability to understand and abide by Federal Centers for Medicare and Medicaid Services guidance. Fast paced environment with frequent priority changes. Organization and follow up abilities will be critical. Policy and reconciles daily systemic eligibility discrepancies. Responsibilities Reconciliation of all daily, weekly and monthly Me
Email Job
Posted 3 days ago
HEDIS Quality Auditor II RN
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ / Wall, NJ / Hopewell, NJ
Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS
Email Job
Posted 4 days ago
RN II, Primary Nurse Care
Horizon Blue Cross Blue Shield of New Jersey
-
Wall, NJ / Hopewell, NJ / Newark, NJ
This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu
Email Job
Posted 4 days ago
Tax Analyst I
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The Tax Analyst I is accountable for assisting with the compliance of federal, state and local tax laws and is accountable for the filing of assigned federal and state income, premium, franchise and other tax returns. This position will contribute to the company's payroll tax compliance as well as Federal & State tax laws. This position will also ensure compliance with th
Email Job
Posted 4 days ago
Cyber Security Analyst II
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The Cyber Security Analyst II supports a 24/7/365 Security Operations Center (SOC) and provides 2nd Tier analysis and response to security events. Actively prepares for, and hunts for, malicious internal and external threats as a part of our cyber incident response program in the Security Operations Center (SOC). CSA II will analyze malware, emerging threats and emerging
Email Job
Posted 4 days ago
Mgr, Medical Cost Mgmt
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
Responsible for managing multiple aspects of the Enterprise medical costs structure including both on system and off system medical costs and directly lead efforts across the Enterprise to provide and present meaningful medical cost trend analysis to drive opportunities and decision making. Collaborate with multiple Commercial and Government Program business partners, inc
Email Job
Posted 4 days ago
Call Center Service Associate (Omnia)
Horizon Blue Cross Blue Shield of New Jersey
-
Hopewell, NJ
Provide excellent service to customers through the resolution of basic customer inquiries received by phone or though written correspondence. Responsibilities Receive customer inquiries via phone, fax, mail, e mail, etc. If necessary, probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry. Review computer
Email Job
Posted 5 days ago
Account Manager III
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
This position is accountable for the conservation of existing accounts and selling additional product lines where appropriate and profitable for the SHBP, Public, and Jumbo markets. This position as it functions in the Labor market will be accountable for servicing of existing accounts as well as selling new business. Manages contract renewals and ensures services are pro
Email Job
Posted 5 days ago
Managed Care Coordinator I
Horizon Blue Cross Blue Shield of New Jersey
-
Hopewell, NJ
This position supports the Clinical Operations functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators Responsibilities Performs review of service requests for completeness of information, collection and transfer of non clinical data, and acquisition of structured clinical data from physicians/pa
Email Job
Posted 5 days ago
LPN II
Horizon Blue Cross Blue Shield of New Jersey
-
Wall, NJ
This position is responsible for performing LPN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care under the direction/supervision of an RN. Performs duties and types of care management as assigned by management. Responsibilities Performs the following job responsibilities under the direc
Email Job
Posted 5 days ago
Clinical Analyst Analyst III-4
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to
Email Job
Posted 6 days ago
Mgr., Clinical Analytics-2
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The Manager of Clinical Analytics is a managerial position requiring excellent leadership, communication, and data analytics technical skills. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to support clinical performance analytics, development, and reporting that deliver actionable clinic
Email Job
Posted 6 days ago
Clinical Analyst Analyst III-2
Horizon Blue Cross Blue Shield of New Jersey
-
Newark, NJ
The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to
Email Job
Posted 6 days ago
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