HorizonBlue Cross Blue Shield New Jersey Jobs & Careers

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27 HorizonBlue Cross Blue Shield New Jersey jobs found on Monster.

Jobs 1 to 20 of 27
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: The IT Audit Manager is responsible for the development and execution of the annual IT audit plan and the achievement of department goals. This position will also support the operational and financial audit team in the execution of integrated audits that focus on both process level and underlying computer application controls, as well as pre-implementation reviews of new applications...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
Job Summary: This position performs analysis and assists in recommendations on a variety of treasury activities, including but not limited to, banking relationships, cash management and posting of Suspense items. Responsibilities: Monitor claims refunds received via lockbox, assist with large items and clear timely Monitor claims refunds marked as exceptions and work with Accounting clerks to reso...
Horizon Blue Cross Blue Shield of NJ Ewing, NJ, 08560
Job Summary: This position is responsible for primarily managing the relationship between Horizon-BCBSNJ and the vendor for services as defined by contract. This includes conducting a review of vendor activities and providing direction to ensure performance service goal levels are met in the areas of customer satisfaction, billing, information systems requirements, performance guarantees, training...
Horizon Blue Cross Blue Shield of New Jersey - PROD Trenton, NJ, 08601
Job Summary: In a call center environment, this position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: Responsible for managing the IT business relationships at a Divisional VP level. Prioritizes Horizon's investment in building capabilities to support and enable business and technology strategies. Ensures the economic return on these investments, and monitor the effectiveness and efficiency of the delivery of the capability building initiatives. Has the end to end accountability for t...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The job of the Director, Customer Service Center is a highly specialized position for directing employees engaged in the face to face customer activity from a day to day operational perspective working with the Divisions Services organization. The person will direct the organization with communication to the senior management in the event of any escalations and business outages. This includes Qual...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Manager, Information Technology I – Desktop Engineering position has technical and management responsibilities for the Desktop Engineering area. The individual assigns work, develops and maintains project plan, performs resource management, develops time and cost estimates, monitors budget for area of responsibility and performs HR activities for team members. The individual directs the team b...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Infrastructure Analyst IV – Desktop Support is responsible for monitoring, supporting, and participating in the development / enhancements of desktop computing platforms. Resolve issues through level 3 for operating systems or other software under the control of the Desktop Engineering team Provide guidance to junior infrastructure analysts and follows guidance and direction from Lead and seni...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Infrastructure Analyst IV – MS Exchange is responsible for monitoring, supporting, and participating in the development/enhancements of distributed system management platforms. Resolve issues through level 3 in server, operating systems or other software under the control of the Distributed Systems management team Provide guidance to junior infrastructure analysts and follow guidance and direc...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Compliance Requirements Associate – Medicare is responsible for the identification and communication of new, revised and pending Medicare Advantage and Part D laws, regulations and standards (collectively, "requirements') relevant to the organization's business. The role will: Monitor information sources related to changes in Medicare Advantage and Part D requirements. Assist in summarizing an...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Manager of Enterprise Business Process Improvement reports to the Director of Enterprise Business Process Improvement and is responsible for guiding process improvement projects to reduce cost and complexity across the enterprise. As a manager of business process improvement (BPI) projects, the incumbent will define deliverables, structure project workplans and provide thought leadership to so...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
The Manager of Enterprise Business Process Improvement reports to the Director of Enterprise Business Process Improvement and is responsible for guiding process improvement projects to reduce cost and complexity across the enterprise. As a manager of business process improvement (BPI) projects, the incumbent will define deliverables, structure project workplans and provide thought leadership to so...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07105
This position establishes and oversees the strategic direction of the records and information management program for the Company. This position will (1) ensure and facilitate compliance with legal and regulatory obligations, (2) promote the efficient use of Company resources devoted to managing records and information, and (3) oversee management of the Company’s records in all formats and througho...
Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ, 08560
The Program Director: Government Programs has overall responsibility for planning, directing, and coordinating activities pertaining to the startup and ongoing operations of this Horizon business division, which encompasses Medicare, Medicare Supplemental, and Medicaid (including MLTSS) lines of business. Much of the initial work will be on planning and coordinating the strategic vision and implem...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Overview: This position will be part of an innovative program changing the model for health care delivery. The Partner Outcomes and Relationships Specialist is a member of Horizon Healthcare Innovations (HHI) Clinical Innovation team, and supports the Manager, Partner Contracting, Outcomes and Relationships for the on-going assessment and support of practices participating in the programs. The...
Horizon Blue Cross Blue Shield of NJ Newark, NJ, 07101
Job Summary: This position is responsible for conducting on site audits of hospital billing and coding practices and desk audits; forms development, profiling and tracking institutional audit trends. Performs and finalizes multiple per diem, bill verification, DRG Validation (utilization review audits) and credit balance. Additionally provides guidance/instruction to various stakeholders on ICD9-...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Summary: Provides case management services for PIP and/or workers compensation cases with lost time, complex medical care, and/or high medical utilization. Ensures appropriateness and cost effectiveness of care, and optimal outcomes. Coordinates cases with internal and external claim representatives, clients, employees, providers and attorneys. Responsibilities: Performs initial and ongoing re...
Horizon Blue Cross Blue Shield of New Jersey - PROD Newark, NJ, 07101
Job Overview: This position will work independently to collaborate with sales to coordinate, drive, and write quality Request for Proposal (RFP) and Request for Information (RFI) submissions along with executing on multiple deadlines. Major Responsibilities: Coordinates and drives the RFP and RFI process including proofreading of all materials. Attends and prepares for strategy meetings, raising i...
Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ, 08628
The Divisional Information Leader III identifies changes and trends in computer and systems technology and interprets their meaning to senior management. The candidate participates in overall business planning; bringing a current knowledge and future vision of technology and systems as related to the organization’s competitive position. Additionally, the role determines long term organization wide...
Horizon Blue Cross Blue Shield of New Jersey Newark, NJ, 07101
Job Summary: This is a senior-level analyst position within the Actuarial department. It will support development of different provider payment models. Responsibilities: Analyze provider performance Communicate with customers to define requirements, determine most appropriate method to obtain information and perform analysis, collect data and information needed, develop models to analyze financial...
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