Account Benefit Manager

100 Horizon Healthcare Services, Inc; Newark (NJ); On-site; USD 79,000 - 106,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Volunteer time off

Tuition reimbursement

Job summary

Horizon BCBSNJ is seeking a detail‑oriented professional to interpret and document benefit and client profile information used across internal teams. You will prepare materials for client sign‑off and serve as the source for coding claim, enrollment systems and contracts.

You will lead off‑site client meetings, provide recommendations with cost implications, and coordinate with the Benefit Coding team to confirm production loading. A NJ license and CEBS are preferred.

Qualifications

• Bachelor's degree preferred or 5 years of equivalent health benefits experience.
• Requires 5+ years of benefit experience.
• Strong written communication skills and ability to interact with senior level individuals.

Responsibilities

• Interpret, document, review, update and issue all benefit and client documentation.
• Present documentation to clients for sign-off and use as source material for coding systems and contracts.
• Conduct off-site client meetings to review benefit documentation and obtain client validation.
• Coordinate internal reviews to ensure accurate interpretation of benefit paperwork.
• Review designs in new business proposals and develop counter recommendations for non‑standard benefits.
• Oversee enrollment/claims/billing issues for first 30 days of new accounts.

Skills

Strong written communication

Interacting with senior leaders

NJ Health/Life license

CEBS designation preferred

Education

Bachelor's degree preferred

5 years equivalent health benefits experience

Job description

About the Role

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

What You'll Do

• 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, prepares 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.

What You Bring

Education/Experience 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.
• Additional licensing, certifications, registrations: Requires a candidate with a New Jersey State Health/Life License or the ability to procure one within six (6) months of employment Certified Employee Benefit Specialist (CEBS) designation preferred.
• Knowledge: Requires in depth knowledge of HBCBSNJ products.
• Requires knowledge of HBCBSNJ claim and enrollment systems.
• Requires knowledge of Insurance Industry, specifically, Group Health insurance.

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.

Salary Range

Salary Range: $79,100 - $105,945 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.

Compensation and Benefits

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.

Job Summary

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.

About Us

We are the leading health insurer in New Jersey, trusted by generations of families and businesses. We are dedicated to enriching the lives and health of our members and the New Jersey communities we serve, because we live and work here too.

Our Mission

We empower our members to achieve their best health.

Our Vision

We are New Jersey’s health solutions leader driving innovations that improve health care quality, affordability and member experience in the markets we serve.

Equal Opportunity/Affirmative Action

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.