Business Systems Analyst IV (Benefits Coding)

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. 

About the Role

What You'll Do

• Lead the process of identifying and recommending coding solutions for enterprise projects and complex benefit coding problems

• Validate and approve business requirements

• Understand Mandates, Product Development coding grids and BRDs and interpret what is required for benefit updates

• Create and deliver work estimates to Project Managers

• Document project one-pager dashboards with schedule, budget, blockers, progress

• Assist with claims testing scenarios

• Document standard operating procedures

What You Bring

Education/Experience:

• High School Diploma/GED required

• Bachelor degree preferred or relevant experience in lieu of degree

• Graduate studies or professional development activities preferred

• 6-8 years of related IT work experience preferably in the health insurance industry

• Demonstrated experience in a key role in major company initiatives and demonstrated leadership experience

• Needs strong product and benefit knowledge

• Prefer experience in benefit coding via HRBK (Via NASCO) or Benefact.

• Needs strong claims processing skills

Special Licensing or certifications:

• Preferred Business Analyst Certification

Knowledge:

• Requires knowledge of system development life cycle and implementation methodologies

• Requires excellence in structured query languages, or analysis techniques

• Requires strong ability to apply structure to loosely defined complex problems

• Demonstrates understanding of core business functions

• Needs strong communication skills

• Needs strong problem solving and analytical skills

• Prefer procedure, diagnostic code knowledge

Skills:

• Requires skillful project execution experience and knowledge

• Requires excellent verbal and written communication skills

• Requires knowledge of programming, development, and technical architecture

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.  We believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

​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

Disclaimer:

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.