Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve 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 better serve and care for the 3.5 million people who place 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 thrive. When our employees bring their best and succeed, the Company succeeds. 

About the Role

This position is accountable for providing support to Network Data Management and all departments utilizing provider date including the screening of provider loading, as well as coordinating all procedural aspects relative to the Government Programs provider systems. This position is also responsible for handling important or sensitive projects and priorities that require a high degree of attention and performing other duties as assigned by management.

What You'll Do

• Assists with the direction and supervision activities of the Provider File Area to ensure the accurate, complete and timely maintenance of the Government Programs provider data files.
• Resolve provider data errors by identifying causation and recommend improvements, identifying strengths and documenting best practices. Investigates all incidents impacting the data integrity and programs to allow for analysis of trends and potential vulnerability.
• Assist in the preparation, development and analysis of specifications for system enhancements and modifications to ensure provider files integrate properly with current and planned systems.
• Produces and develops specifications and user testing criteria while securing appropriate documentation to assure accurate data in file.
• Evaluate and recommend improvements to specific current operating procedures to enhance operating efficiencies and controls.
• Handle important or sensitive projects and priorities that require a high degree of attention.
• Produce departmental reporting for quality and production, including vendor audits.
• Provide departmental representation on workgroups and committees.

What You Bring

Education/Experience:

• High School Diploma/GED required.
• Minimum of 5 years relevant work experience in provider data management in Healthcare/ insurance is required.

Preferred Knowledge:

• Knowledge of healthcare provider systems and claims processing systems.  
• Understanding of managed care and indemnity business models and operations. 
• Familiarity with provider credentialing processes, provider data integration, system enhancement projects, and testing methodologies. 
• Knowledge of medical terminology and healthcare procedures. 
• Experience supporting vendor audits, compliance activities, or operational reporting. 
• Use of AI tools to support operational efficiency.

Skills and Abilities:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.
• Requires excellent attention to detail.
• Requires excellent analytical abilities and the ability to report findings accurately.
• Requires excellent oral and written communication skills.
• Requires the ability to interact with all levels of personnel and management.
• Requires the ability to organize and prioritize work assignments.
• Requires the ability to work independently and exercise sound business judgment.
• Prefer the ability to understand medical terminology and medical procedures.

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 believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$63,000 - $84,420

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, 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 recruiting and hiring process.