JOB DESCRIPTION

Job Summary:

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies as part of business process improvement (BPI) initiatives. 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.

Responsibilities:

* Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary.

* Research and suggest business process solutions.

* Develop forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)

* Develop solutions based on data analysis to increase business efficiency.

* Lead or participate in internal and external project workgroup(s) and presentations.

* 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.

* Identifies process improvement opportunities

* Gather, process FCR and performance data and conduct trending and root cause analyses.

* Design and develop standard reports for metrics reporting and analysis.

Education/Experience:

* Bachelor's degree required.

* Minimum of seven (7) years' experience in an operational role, or analytical role

Knowledge:

* Required knowledge of Healthcare industry operations (provider network support, claims, encounter processing, member enrollment, etc).

* Knowledge of Project Management methodologies.

* Prefer knowledge of Horizon Blue Cross Blue Shields products and services.

* Prefer working knowledge of division operating plan and Horizon operating model.

Travel:

* Some travel may be required within NJ.

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

Requirements:

Education
Bachelors

Job Level
Individual Contributor

Expertise
Business Process Improvement

Job Type
Full Time

Location
Ewing, NJ