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Medicare Analyst

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POST DATE 9/3/2016
END DATE 10/8/2016

Horizon Blue Cross Blue Shield of New Jersey Newark, NJ

Newark, NJ
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED


Job Summary:

This position is responsible for ensuring that Medicare Advantage membership enrollment is in sync by reconciling CMS enrollment records and Horizon enrollment records via review of Daily Transaction Reply Reports (DTRR) and the Monthly Membership Reports (MMR) while abiding by Federal Centers for Medicare and Medicaid Services guidance.


* Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS.

* Research and resolve enrollment discrepancies identified as a result of company and MMR report and Horizon records.

* Directly respond or support a response to inquiries that is rapid and professional to internal and external customers, not limited to Medicare Beneficiaries, Federal Regulators, Executives and Congress persons.

* Generating and ensuring compliance and accuracy of various types of member correspondence specific to retroactive enrollment submission to CMS.

* Identification and communication of processing performance opportunities.

* Responsible for updating beneficiary requests for enrollment for premium withholding.

* Ensure that on a monthly basis all identified discrepancies resolutions are met with CMS timeframes.

* Prepare case documents for retroactive enrollment updates.

* Performs other duties as assigned by management.


* High School diploma or GED required, Bachelor's degree from an accredited college or university preferred.

* Minimum of 5 years health insurance industry or related Medicare experience.

* Excellent oral and written communication skills.

* Strong analytical and problem solving skills.

* Proficiency in analysis techniques and Access database.

* Knowledge of system development life cycle and implementation methodologies preferred.

* Prefer ability to translate CMS regulatory guidance.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to the job. The job description is not intended to be an exhaustive list of all responsibilities, duties and skills required of each incumbent.

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.


High School Diploma

Job Level
Individual Contributor

--Horizon NJ Health

Job Type
Full Time

Newark, NJ