Policy Support Specialist

Job not on LinkedIn

🔥 2 minutes ago

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

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

💵 $52.8k - $70.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

👻 Ghost score 10%

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

• Research member medical records to resolve claims or service requests that pend with clinical edits for all lines of business. • Review medical policies and determine appropriate claim processing or clinical review process decisions. • Coordinate clinical review and appeal processes, including preparing cases for clinical review and requesting additional information from members and providers. • Review clinical determinations and initiate appropriate claim adjustments and service requests closeout, including drafting manual letters. • Review and determine pricing for clinical claims in accordance with negotiated pricing agreements. • Review and update Coordination of Benefit (COB) files and submit provider file updates as necessary. • Identify technical issues and submit them to the appropriate area for resolution. • Handle relevant incoming telephone inquiries as needed. • Perform other tasks as assigned by management.

🎯 Requirements

• Minimum of a High School Diploma or GED equivalent required. • Requires three (3) years of health care claims processing experience including researching and investigating customer inquiries. • Requires a minimum of two (2) years of experience with medical terminology, billing and coding. • Knowledge of COB and Horizon medical policies preferred. • Knowledge of all lines of business preferred. • Strong analytical and critical thinking skills preferred. • Strong organizational and communication skills. • Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

🏖️ Benefits

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