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 will serve as subject matter expert on vendor analytics & performance and retrospective & prospective target analytics for risk adjustment programs. This position involves manipulating large amounts of big data (vendor and risk). The analyst will research, analyze, validate, and prepare data across multiple system platforms and sources. In addition, the analyst will build reports to track various risk adjustment activities and fulfill business needs.
What You'll Do
Serve as a subject matter expert on vendor analytics (cost, quantity, services, contract (terms, timelines, deliverables) and performance (SLA & Penalties)) and retrospective and prospective target analytics for risk adjustment programs.
Perform vendor and risk analytic studies which involves manipulating large amounts of data.
Create retrospective and prospective target lists for risk adjustment programs.
Support EDGE supplemental submission. (e.g. mapping claim id(s) to vendor records).
Identify patterns and trends in diagnostic coding practices in conjunction with risk score measurement.
Provide complete and accurate information for vendor audits (costs) and government audits (CMS) related to Risk Adjustment.
Conduct ad-hoc analysis like gap and root cause.
Periodically update process flow charts for business stakeholders.
Identify problems within Enterprise Resource Planning (ERP) system such as reporting limitations and recommend solutions.
Research, analyze, validate, and prepare data across multiple system platforms and sources for use in monitoring and reporting.
Build reports for internal customers to track various risk adjustment activities and fulfill business needs.
What You Bring
Education/Experience:
High School Diploma/GED required.
Bachelor degree in Accounting, Finance, Mathematics, Statistics, Economics, Actuarial Science or other analytical field preferred or relevant experience in lieu of degree.
Requires a minimum of 4 years’ experience in accounting.
Proficient in at least one programming language (VBA, SQL, SAS, R).
Additional licensing, certifications, registrations:
Knowledge:
Knowledge of accounting entries/accruals/month-end close process.
Knowledge of data analysis and Actuarial principles.
Knowledge of database applications.
Skills and Abilities:
Experience working in Excel, VBA programming is a plus.
Experience programming in SAS/SQL .
Predictive Analytic experience a plus (Linear, GLMs, Tree Based models).
Medicare, Medicaid, or commercial risk adjustment experience is a plus.
Experience with ERP systems (Workday).
Experience with Billing/Purchasing/Procurement.
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:
$87,300 - $119,070
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:
Disclaimer:
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. 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.
