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

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.Responsibilities:

• 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.

Disclaimer:
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.

Education/Experience:

• High School Diploma/GED required.

• Minimum of 5 years health insurance industry or related Medicare experience

Knowledge:

• Proficiency in analysis techniques and Access database

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

Skills and Abilities:

• Excellent oral and written communication skills.

• Strong analytical and problem solving skills.

• Prefer ability to translate CMS regulatory guidance.

Salary Range:

$61,200 - $81,900

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

Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

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.