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 role is responsible for the oversight of the Blue Cross Blue Shield Association (BCBSA) National Program (BlueCard) processing requirements and standards, and ensures policies and provisions are incorporated into the Plans practices and procedures. This position is also responsible for BCBSA and InterPlan complaints, escalations, and second blue bids across the Enterprise. This position is also accountable for BlueCard cross-divisional strategic initiatives and process improvement projects and ensures departmental compliance with BCBSA and internal regulatory policies and procedures, and related mandates. This position will be assigned as the BlueCard Executive Alternate.What You'll Do
Develops and maintains internal/external business partnerships and represents department/enterprise on BlueCard matters as necessary.
Manage the timely resolution of the InterPlan and BlueCard executive escalations.
Coordination of all Second Blue bids and ensure SLA and reporting requirements are met.
Ensure all BCBSA performance scores cards are meeting requirements across the organization.
Coordinate and track all BCBSA exception requests and action plans.
Manages all BCBSA and other Blue Plans communications and Information Requests related to National Programs (BlueCard), and works closely with the appropriate Horizon business partners, InterPlan Executive, BlueCard Executive and Association Leads to take appropriate actions.
Develops and tracks information requests from BCBSA and Blue Plans, monitoring and reporting on the status.
Communicates the Horizon concepts for administering/developing strategic programs that will impact National Programs (BlueCard) programs across Horizon, BCBSA and Blues Plans.
Communicates the Horizon concepts for administering/developing strategic programs that will impact National Programs (BlueCard) programs across Horizon, BCBSA and Blues Plans.
Review materials and coordinate with Service Learning and Development to educate internal stakeholders about the FEP and Inter-Plan Program policies.
Responsible for the integration of activities, processes, workflows, tools and technologies needed to administer BlueCard and FEP programs across Horizon, Association and Plan business and technical areas.
Ensure the requirements of the National Programs processing standards, policies and provisions are incorporated into the Plans practices and procedures.
Reviews and influences requirements and enhancement development for National Programs across business and technical departments at Horizon and the Association.
Attend Association workgroup meetings, acts as secondary contact for escalated complaints from the Association as the designated BlueCard Executive Alternate.
Manage, develop, and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
What You Bring
Education/Experience:
High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Requires a minimum of 5+ years of management experience.
Requires experience in project management.
Requires experience in Healthcare with legal and regulatory compliance background.
Knowledge:
Knowledge of BCBSA National Programs (BlueCard, InterPlan, FEP), including policies, processing standards, and governance requirements.
Knowledge of healthcare operations and regulatory compliance impacting inter‑plan and national program activities.
Knowledge of project management, performance metrics, and cross‑functional process integration in a regulated healthcare environment.
Skills and Abilities:
Ability to interact and influence senior leaders of the organization.
Excellent supervisory/management skills.
Strong analytical and problem solving.
Superb conflict management and relationship management skills.
Excellent facilitation, coaching and platform skills.
Travel (If Applicable):
Minimal travel required.
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:
$109,600 - $149,625This 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. 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.