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Quality & Oversight Analyst

Company: Horizon Healthcare Services, Inc
Location: Newark
Posted on: August 4, 2022

Job Description:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This position is responsible for supporting the CBU in the areas of audits, mandate implementation, quality assurance over sales processes, and other responsibilities, as described in more detail below.In conjunction with Corporate Compliance and Ethics, prepares and executes the Commercial Business Unit annual compliance plan.Assists in the coordination of Commercial Business Unit external, regulatory or internal audits or requests.Prepares the CBU Risk Dashboard and report in collaboration with subject matter experts and CBU leadership.Represents the CBU with respect to implementation of mandates that impact CBU products, services or processes and issue Infobriefs and Brokerbriefs as needed.Prepares the CBU Compliance and Audit dashboards, including tracking and monitoring of outstanding audit issues Oversees filings and mailings as needed, including the Part D Creditable Coverage Mailing and NAIC Market Conduct Annual Statement data filing.Serves as initial point of contact for Sales and Account Management teams regarding mandates, CBU policies and regulatory questions.Reviews OMNIA benefit documentation for quality including the Summary of Benefits and Coverage and other product specific documents.Prepares and updates, as necessary, policies and procedures for the CBU. Serves as Records Retention Coordinator for the CBU.The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.Education/ExperiencePrefers Bachelor's degree from an accredited college or equivalent work experience.Requires a minimum of 7 years of experience in Healthcare field or relevant field.KnowledgeKnowledge of health insurance products and services, including managed care, insurance and self-funded products.Knowledge of the Federal and State regulatory environment in the health insurance industry, with emphasis on Federal and State benefit mandates, the Affordable Care Act, HIPAA and ERISA.Skills and AbilitiesOrganization and management of multiple priorities.Proficient in various Microsoft software products.Written and verbal communication skills.Attention to detail.Listening skills.Problem solving.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.

Keywords: Horizon Healthcare Services, Inc, Newark , Quality & Oversight Analyst, Professions , Newark, New Jersey

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