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

Job Summary:

• Perform and support trend analysis
• Perform risk adjustment analytical studies that involve manipulations of large amounts of data.
• Identify patterns and trends in diagnostic coding practice in conjunction with risk score measurement.
• Conduct gap analysis and data collection and validation.
• Stay abreast of government regulations as related to the 3R's.
• Quantify and project risk scores and revenue for the Medicare line of business
• Serve as subject matter expert for Medicare regulations, procedures, and requirements
• Conduct complex actuarial analyses to assess risk scores
• Create data-driven solutions for capturing risk and improving quality of care for our members
• Perform vendor return on investment analyses to determine ongoing benefit and decision support
• Develop and execute work plans that may involve collaboration with more than one team
• Identify systems and operational problems, and recommend solutions and changes to streamline procedures for more effective reporting
• Perform root cause analysis
• Present and explain results to executive leadership
• Other responsibilities as assigned
• Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.
• Monthly P&L financial reconciliations and frequent liaisons with the Finance team
• Present reports, explaining their implications to managers and directors, and advising on risk limitation
• Communicating with internal clients and carrying out relationship with financial directors and stakeholders
• Ad-hoc modeling and projects.

Education/Experience:

• Requires a Bachelor's degree, preferably within Mathematics, Statistics, Actuarial Sciences or a related field from an accredited college or university
• 2 years of actuarial and/or statistics experience
• Experience in the health insurance industry preferred
• Associate, Society of Actuaries (ASA) preferred

Knowledge:

• Requires working knowledge of Excel
• Prefers working knowledge of Access or other database application
• Prefers experience with SAS or other programming language
• Prefers knowledge of data analysis and Actuarial principles
• Requires good oral and written communication skills
• Requires strong analytical thinking
• Requires strong mathematical skill and statistical analysis abilities
• Requires good judgment and problem solving skills
• Medicare or Commercial Risk Adjustment experience
• Other healthcare experience, especially technical experience

Skills and Abilities:

• Requires good oral and written communication skills
• Requires strong analytical thinking
• Requires strong mathematical skill and statistical analysis abilities
• Requires good judgment and problem solving skills

Salary Range:

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

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.