Care Coordination Associate – Managed Care

Horizon Blue Cross Blue Shield of New Jersey; United States; Remote; USD 45,000 - 60,000; Full time

Benefits offered by this job

Comprehensive health benefits (Medical

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Healthcare Support Specialist to bridge Clinical Operations between Members, Physicians and Care Managers. You will review service requests, coordinate information flow, and follow up to ensure case completion while supporting utilization management and case management functions.

The role emphasizes strong medical terminology knowledge, effective communication, and the ability to navigate contracts, enrollment data, and claims processing

Qualifications

• Knowledge of medical terminology.
• Strong oral and written communication.
• Ability to make sound decisions under supervision.
• Familiarity with contracts, enrollment, billing & claims processing.
• Understanding of Managed Care principles.
• Analytical mindset and problem-solving ability.
• Proficiency with computers and clinic/claims systems.

Responsibilities

• Review service requests for completeness and collect/transfer non-clinical data.
• Prepare and route cases for clinical review; initiate callbacks to members/providers.
• Coordinate case completion with physicians and members as needed.
• Review professional medical/claim policy issues or claims in pending status.
• Act as liaison with providers, members and Care Managers.
• Perform other relevant tasks assigned by Management.

Skills

Medical terminology

Communication skills

Decision making

Contracts & billing knowledge

Managed Care principles

Problem solving

PC & software proficiency

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Healthcare Support Specialist to bridge Clinical Operations between Members, Physicians and Care Managers. You will review service requests, coordinate information flow, and follow up to ensure case completion while supporting utilization management and case management functions.

The role emphasizes strong medical terminology knowledge, effective communication, and the ability to navigate contracts, enrollment data, and claims processing