Business Analyst III

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); Vor Ort; USD 87.000 - 119.000; Vollzeit

Benefits dieser Stelle

Health benefits

Retirement plans

Paid PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Zusammenfassung

Horizon Blue Cross Blue Shield of New Jersey is seeking a senior analyst to conduct research and root cause analysis to improve operational performance across departments. You will interpret regulatory requirements, translate business needs for IT, and guide cross-functional teams through audits and process improvements.

The role requires seven+ years in operational or analytical work, a high school diploma or bachelor’s degree, and knowledge of healthcare regulations.

Qualifikationen

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of seven (7) years' experience in an operational or analytical role.

Aufgaben

• Analyze regulatory materials to understand assigned mandate and EOB requirements.
• Serve as SME for assigned mandates with Legal, Compliance, Privacy, Ops, IT, and business teams.
• Collaborate with BSA to develop IRF and HLBC scope summary.
• Ensure Compliance is engaged at the appropriate level.
• Translate business requirements and assist IT with technical specs.
• Develop solutions based on data analysis to improve efficiency.
• Lead or participate in internal/external project workgroups and presentations.
• Conduct User Acceptance Testing (UAT) for projects and fixes.
• Prepare materials for audits and review findings for accuracy.
• Mentor less experienced staff and support onboarding.
• Perform other tasks as assigned.

Kenntnisse

Root cause analysis

Regulatory materials analysis

Stakeholder communication

Ausbildung

High School Diploma/GED

Bachelor degree preferred

Jobbeschreibung

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

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situations.

What You'll Do

• Analyze regulatory materials, guidance, communications, and correspondence to understand assigned mandate and EOB requirements.
• Serve as the subject matter expert for assigned mandates and partner with Legal, Compliance, Privacy, Operations, IT, and business teams to interpret requirements.
• Partner with the assigned Business Systems Analyst (BSA) to develop the Initiative Request Form (IRF) and project scope summary, ensuring mandate requirements, compliance considerations, and impacted business areas are accurately represented to support development of the High‑Level Business Case (HLBC).
• Ensure Compliance is engaged at the appropriate level (stakeholder, approver, etc.).
• Translate business requirements and assist IT with the development of technical specifications.
• Develop solutions based on data analysis to increase business efficiency.
• Lead or 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; review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective action steps.
• May coach/mentor less experienced staff, assist in on‑boarding of new staff and/or distribute and follow‑up on work assignments.
• Perform other relevant tasks as assigned by management.

What You Bring

Education/Experience:

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Minimum of seven (7) years' experience in an operational role, or analytical role.

Knowledge:

• Knowledge of Healthcare industry required.
• Knowledge of Project Management methodologies.
• May require knowledge of Horizon Blue Cross Blue Shields products and services.
• May require working knowledge of division operating plan and Horizon operating model.

Travel:

• Some office travel required.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives-while being supported by a missiondriven 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:

$87,300 - $119,070

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

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.