Provider Data Quality & Systems Analyst II

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); On-site; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health benefits

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 data management professional to support Government Programs provider data and coordinated loading across departments. You will screen provider data, resolve errors, and contribute to system enhancements to ensure accurate, integrated provider files.

The role emphasizes attention to detail, analytical reporting, and collaboration with multiple teams. Strong MS Office skills and healthcare terminology knowledge are essential in this on-site

Qualifications

• High School Diploma/GED required.
• Minimum of 5 years relevant work experience in provider data management in Healthcare/insurance.
• Knowledge of healthcare provider systems and claims processing.
• Understanding of managed care and indemnity business models and operations.
• Familiarity with provider credentialing processes, provider data integration, system enhancement projects, and testing methodologies.
• Knowledge of medical terminology and healthcare procedures.
• Experience supporting vendor audits, compliance activities, or operational reporting.
• Use of AI tools to support operational efficiency.

Responsibilities

• Assists with the direction and supervision activities of the Provider File Area to ensure accurate, complete, and timely maintenance of Government Programs provider data files.
• Resolve provider data errors by identifying causation and recommend improvements; document best practices.
• Assist in preparation, development and analysis of specifications for system enhancements and integrations.
• Develop specifications and user testing criteria and secure documentation for data accuracy.
• Evaluate and improve current procedures to enhance efficiency and controls.
• Produce departmental reporting for quality and production, including vendor audits.
• Represent the department on workgroups and committees.

Skills

MS Office

Analytical skills

Attention to detail

Communication skills

Independent work

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a data management professional to support Government Programs provider data and coordinated loading across departments. You will screen provider data, resolve errors, and contribute to system enhancements to ensure accurate, integrated provider files.

The role emphasizes attention to detail, analytical reporting, and collaboration with multiple teams. Strong MS Office skills and healthcare terminology knowledge are essential in this on-site