Mandate Negotiation Analyst – 1

Job not on LinkedIn

🕒 July 22

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $58k - $77.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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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

• Manage the resolution of out of network billing disputes • Handle the negotiation cases within the regulatory timeframes • Timely and accurate creation and closure of Interactions and Intents • Completion of eligibility verification upon assignment of new mandated cases • Interact with relevant parties to facilitate timely and accurate negotiation resolution • Research and review of negotiation attempts • Update high dollar negotiation files • Prepare written responses including negotiation outcomes • Handle escalated complaints from CMS/DOBI/DOL and Legal/Litigation • Conduct detailed root cause analysis • Participate in staff meetings as deemed appropriate • Creation of GSI’s and logging of cases

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires five years of business experience which must include two+ years of correspondence and/or telephone customer service experience screening, investigating and examining inquiries • Experience in claims processing necessary • Ability to navigate the various claims and service operations systems • Healthcare industry experience helpful • Knowledge of HBCBSNJ complaints and appeals process preferred • Knowledge of insurance claim and membership systems preferred • Knowledge of medical terminology, COB, Medicare procedures preferred • Knowledge of UCSW preferred • Knowledge of Claims Policy guidelines preferred • Knowledge of Microsoft Office Suite required.

🏖️ Benefits

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