Business Analyst II

Horizon Healthcare Services•Newark, NJ

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. Under general supervision conducts research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is an intermediate level position and may require guidance.

Requirements

High School Diploma/GED required.
Minimum of four (4) years' experience in an operational role, or analytical role.
Knowledge of Healthcare industry preferred.
Strong Computer Skills-Microsoft Office products to include (Access, Word, Excel, PowerPoint, Project, Visio, etc.).
Team Player, Strong Analytical and Interpersonal Skills.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Responsibilities

Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary.
May create forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)
May translate business requirements and assist IT with the development of technical specifications.
Recommend solutions based on data analysis to increase business efficiency and/or improve existing processes.
Participate in internal and external project workgroup(s) and presentations.
Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
Prepare materials for internal and external audit activities; may review audit findings/reports for accuracy and completeness.
Perform other relevant tasks as assigned by management.
Support in developing or drafting Business Requirement documents and identifying process gaps that require the creation or revision of workflows
Collaborate with Compliance, Legal and the Business Process Improvement teams on special projects to mitigate compliance risks
Identify eligible surprise bill services and coordinate correct cost sharing in claims system
Acts as a Liaison with external vendors to create operational efficiencies, reduce cost, and improve quality
Building of data extracts/reports to monitor surprise billing activity (e.g., number of disputes, provider trending, win/loss, etc.)
Perform root cause analysis to identify non-compliance trends and potential fraud, enabling cost saving opportunities