Claim/Pend Specialist

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 responsible for initial claim pending resolution and claim adjustments. In addition this position is responsible for the initial examining, coding, and input of claims and referrals into the various processing systems.

What You'll Do

• Resolve edits on claims (pending resolution) and may require claim adjustments.
• Data entry of primary and secondary claims, as well as referrals into various processing systems.
• Return claims with unidentifiable information back to healthcare professional/subscriber with letter requesting additional information.
• Perform general clerical duties to ensure accurate disposition of claims/referrals that cannot be entered into the various processing systems.
• Perform other related duties as required by Management.

What You Bring

Education/Experience:

• ­High School Diploma or equivalent required
• Requires one (1) year of clerical business experience
• Medical Terminology/Billing/Coding experience preferred
• Experience in a Production and Quality driven work environment preferred

Additional licensing, certifications, registrations:

• N/A

Knowledge:

• Must be proficient with the use of personal computers and supporting software in a Windows based environment, including MS Office products.
• Should be knowledgeable in the use of intranet and internet applications; including ability to navigate.
• Strong typing, data entry and keyboarding necessary.
• Must be proficient using a calculator for simple math calculations.

Skills and Abilities:

• Must be detail oriented with good organizational and data processing skills.
• Proven ability to follow detailed instructions is essential.
• Must demonstrate ability to learn quickly and apply learning to new situations.
• Must exhibit flexibility to change as appropriate.

Travel (If Applicable):

• N/A

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:

$41,579 - $55,321

​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:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. 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.