Process Auditor

Overview

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us.

We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

To ensure excellent customer service by responding in a timely, accurate and thorough manner to written and telephone inquiries from hospitals/ancillaries.

• Provide resolution to identified over payments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim.
• Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures.
• Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS).
• Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy.
• Anticipate and resolve potential issues and follow through on commitments made to the customers.
• Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals.
• Follow up on unresolved issues via outbound calls, emails or faxes.
• Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality.
• Submit provider file updates as appropriate.
• Receive inbound telephone calls as they relate to recovery efforts
• Perform other related tasks as assigned by management.

• High School Diploma/GED required.
• 1 to 2 years customer service/benefit processing experience.

• Strong knowledge of Medical terminology preferred.

• Strong PC skills
• Analytical thinking
• Strong written and verbal communication necessary

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

$44,600 - $59,745

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case.

Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

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.