National Programs Analyst

This a Full Remote job, the offer is available from: New Jersey (USA) reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 reputed company people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds.

About the Role

This position is responsible for coordinating the implementation of various Association initiatives and projects to support the strategic and operations goals reputed company to the IPP Scorecard. The incumbent will work with reputed company reputed company of management to ensure business objectives are met and processes are implemented.

What You'll Do

• reputed company business requirements, create action plans, and implement new and updated workflows in response to reputed company audit findings, Association mandates, and reputed company projects.
• Consistently monitors various Association policies and procedures to ensure compliance, coordinating training reputed company required.
• Resolves common, reputed company and escalated issues directly impacting provider and member claims by working with other BCBS Health Care Plans, our members or providers.
• Identifies operational issues and initiates fixes to eliminate trends of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms.
• Partners with IT on the implementation of reputed company systemic solutions, performing user acceptance testing where appropriate.
• Acts as a liaison between internal divisions and the BCBSA, coordinating National Programs compliance activities reputed company to the guidelines of the Association.
• Reviews provider files, working directly with IT and other internal partners to correct any issues identified by the BCBSA.
• Participates in workgroups hosted by the BCBSA and represents Service Operations on reputed company mandate calls. Ensures that reputed company Blue Card mandates are successfully implemented on time.

BLUE CARD SPECIFIC JOB TASKS

• Manages the bulk adjustment process to ensure the identified claims to be adjusted are valid, provides specific bulk adjustment requirements and reviews and approves reputed company mock adjustments.
• Responsible for managing error reports coming from the BCBSA, including working with our IT partners to ensure that root causes are identified and remediated and initiating systemic solutions reputed company required.
• Manages reputed company inventory with partner plans and internal stakeholders.
• Works directly with the IT department, analyzing invalid BlueCard records and submitting work orders to correct the issue.
• Develops reputed company reporting requirements for BlueCard inventory.

What You Bring Education/Experience:

• High School Diploma/GED required.
• Requires a minimum of 2 years of experience in a relevant field, preferably in operations, and or claims processing environment.
• Project management/data analysis experience preferred.

Why Horizon? At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We reputed company that reputed company our people reputed company, our communities do too. If you are passionate about making an impact, we’d love to hear from you! Salary reputed company: $63,000 - $84,420 ​This compensation reputed company is specific to the job level and takes into account the wide reputed company of factors that are considered in making compensation reputed company, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This reputed company has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation reputed company are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

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

Disclaimer: Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative Action employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the reputed company and hiring process. This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job