Medical Policy Analyst

Job not on LinkedIn

🕒 August 14

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $70.5k - $94.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 26%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Perform reviews of post service medical necessity and appealed claims for compliance with appropriate medical policy, plan benefit, and correct/appropriate provider coding • Prepare cases for Medical Director and/or outside consultant review and response where appropriate • Provide timely and accurate responses to inquiries and collaborate with claim policy teams regarding claims pending for medical review and appeal inquiries • Communicate opportunities for development or revision of Horizon Medical Policies based on case review outcomes • Manage assigned inventory, document production, and follow assignments through completion • Stay abreast of mandates, policy, and workflow changes impacting review processes and outcomes • Follow laws, regulations, and policies applicable to the organization’s business

🎯 Requirements

• High School Diploma/GED required • Requires a minimum of 3 years’ clinical nursing experience • Must have effective verbal and written communication skills and demonstrate the ability to work well within a team • Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development • Proven time management skills • Ability to manage multiple priorities or tasks, deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required • Demonstrated ability to work in a production focused environment • Proven ability to exercise sound judgment and strong problem-solving skills • Proven ability to ask probing questions and obtain thorough and relevant information

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement