National Programs Analyst

About the Role This position is responsible for coordinating the implementation of various Association initiatives and projects to support the strategic and operations goals aligned to the IPP Scorecard. The incumbent will work with all levels of management to ensure business objectives are met and processes are implemented. What You'll Do Provide business requirements, create action plans, and implement new and updated workflows in response to Blue Cross Blue Shield Association audit findings, Association mandates, and enterprise projects. Consistently monitor various Association policies and procedures to ensure compliance, coordinating training when required. Resolve common, complex, and escalated issues directly impacting provider and member claims by working with other BCBS Health Care Plans, our members or providers. Identify operational issues and initiate fixes to eliminate trends of untimely, inaccurate, non‑compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms. Partner with IT on the implementation of all systemic solutions, performing user acceptance testing where appropriate. Act as a liaison between internal divisions and the BCBSA, coordinating National Programs compliance activities aligned to the guidelines of the Association. Review provider files, working directly with IT and other internal partners to correct any issues identified by the BCBSA. Participate in workgroups hosted by the BCBSA and represent Service Operations on all mandate calls. Ensure that all Blue Card mandates are successfully implemented on time. Blue Card Specific Job Tasks Manage the bulk adjustment process to ensure the identified claims to be adjusted are valid, provide specific bulk adjustment requirements, and review and approve all mock adjustments. Manage error reports coming from the BCBSA, including working with IT partners to ensure root causes are identified and remediated and initiating systemic solutions when required. Manage open inventory with partner plans and internal stakeholders. Work directly with the IT department, analyzing invalid BlueCard records and submitting work orders to correct the issue. Develop all reporting requirements for BlueCard inventory. What You Bring High School Diploma/GED required. Minimum of 2 years of experience in a relevant field, preferably in operations and/or claims processing environment. Project management and data analysis experience preferred. Salary Range Salary Range: $63,000 - $84,420 Benefits Comprehensive health benefits (Medical/Dental/Vision) Retirement plans Generous PTO Incentive plans Wellness programs Paid volunteer time off Tuition reimbursement Disclaimer & Equal Opportunity Statement Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. 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. #J-18808-Ljbffr 100 Horizon Healthcare Services, Inc