Account Benefit Manager

Horizon Healthcare Services•Newark, NJ

20h•Onsite

About The Position

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 Interpret and document benefit and account profile information utilized by internal departments to accurately service the client and populate downstream systems.

Requirements

Bachelor's degree preferred. In lieu of degree applicant must have 5 years of equivalent and relevant health benefits work experience.
Requires a minimum of 5 years of benefit experience.
Requires strong written communication skills.
Requires ability to interact with senior level individuals ability to interact with senior level individuals.
Requires a candidate with a New Jersey State Health/Life License or the ability to procure one within six (6) months of employment
Requires in depth knowledge of HBCBSNJ products.
Requires knowledge of HBCBSNJ claim and enrollment systems.
Requires knowledge of Insurance Industry, specifically, Group Health insurance.

Nice To Haves

Certified Employee Benefit Specialist (CEBS) designation preferred.

Responsibilities

Interprets, documents, reviews, updates and issues all benefit and client documentation for new and existing clients. This documentation will be presented to the client for sign-off and will be utilized as the source material to code claim/enrollment systems, and to write contracts/booklets which legally define benefit obligations to subscribers and clients.
Conducts off-site client meetings to review benefit documentation, provides recommendations for changes along with cost/saving factors, and obtains client validation.
Facilitates internal review with appropriate areas to ensure accurate interpretation of the benefit paperwork.
Reviews designs in new business proposals, prepare non-standards and develop counter recommendations for benefits we can not administer.
Reviews testing and confirms with Benefit Coding team that coding has been finalized and loaded into production
Maintains all relevant information in corporate databases to facilitate auditing.
Works with the CPL/PIBA team to validate and document benefit information on CPL/PIBA.
Oversees complete implementation of new accounts and trouble shoots enrollment/claim/ billing issues for the first 30 days.
Attends enrollment meetings.
Builds strong relationships with Account Management teams and Internal Departments to facilitate implementation of benefit changes, new lines of business for existing clients, and triage benefit related issues.
Prepare training materials for service team and conduct on-site training.
Assists with pre-implementation audits.