Claims Business Technology Analyst II

Job not on LinkedIn

🕒 2 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $87.3k - $119.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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

• Provides business technical support to operations across the Service Division to ensure successful implementation of automation and efficiency projects/programs to ensure the achievement of claims timeliness and quality goals. • Works with Service departments to coordinate prioritization of projects and works with IT and Claims System vendors (NASCO) for implementation and maintenance. • May conduct User Acceptance Testing (UAT) for Service Division projects, implementations, system fixes and enhancements. • Collaborates with the business groups to develop, document and standardize reporting procedures and workflows to support operational improvement. • Manages Claims Stop governance and maintenance to minimize claims stops and assure discipline, documentation and audit trail. • Leverages existing technology by identifying opportunities to automate manual processes and interventions; identify opportunities to incorporate and standardize new technology into processes and flows. • Creates opportunities by working with IT on new solutions and business on EDI gateway claim editing possibilities. • Works with IT and corporate departments to help monitor service level agreements on Plog timeliness; recommends alternate approaches for handling for effectively. • Work across Service departments to achieve business goals; leverage key internal and external relationships to access the information, products and resources (technology, training, staff, etc.) necessary to successfully support Claims and related Service goals. • Reviews BRDs and offers commentary as required. • Provides Subject Matter expertise to Service teams as needed on business technical issues and audit activities. • Prepare materials for internal and external audit activities, review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective actions steps. • Provides post-implementation check out of system enhancements and thorough overview of enhancements to business owners.

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires broad-based Operations or IT experience with a minimum of 5 years in managed healthcare or related industry. • In lieu of Bachelors degree, an additional 3 years of experience in Operations or IT is required. • Successful track record in managing operations with process improvement background desired. • Past experience on system implementations in a fast-paced, high pressure environment is preferred. • Claims systems knowledge is required. • Project management experience is a plus. • Experience with specialty health plan products/groups helpful. • Prior background in managing change and developing new operations is preferred. • Knowledge of the deep understanding of the NASCO or FACETS system is required. • Knowledge of project management life cycles and related tools and practices is required. • Must have a solid understanding of claim processing including pricing and code editing. • Must have strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects at one time. • Must have strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams.

🏖️ Benefits

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