Top 191 Claims analyst Jobs in Nutley Nj

Claims Negotiation Analyst (Out of Network Mandates)
Horizon Blue Cross Blue Shield of New Jersey —Newark, NJ
- $58,029 - $77,074 a year
- Full-time
- Basic math
- Research
- Mid-level
- Health insurance
- Dental insurance
Medical Policy Analyst
Horizon Blue Cross Blue Shield of New Jersey —Newark, NJ
- $70,500 - $94,395 a year
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Dental insurance
7d
Compliance Analyst
Verisk —Jersey City, NJ
- Full-time
- Hybrid work
- 18 years or older
- Microsoft Excel
- Mid-level
- Health insurance
- Paid time off
LOGISTICS ANALYST
Formosa Plastics Corporation, USA —Livingston, NJ
- $82,706 - $107,462 a year
- Full-time
- Mid-level
- Microsoft Office
- Analysis skills
- Paid holidays
- Disability insurance
Analyst, Customs and Trade Compliance – North America
Michael Kors —East Rutherford, NJ
- $85,000 - $95,000 a year
- Full-time
- Mid-level
- 3 years
- Analysis skills
CLAIM ADMIN-PRGM ANALYST
Dassault Falcon Jet Corp —Little Ferry, NJ
- $70,000 - $90,000 a year
- Overtime
- Computer Science
- Mid-level
- Office
- Health savings account
- Health insurance
Quick Apply
Financial Application Analyst II - Full Time - Days - Corporate
Atlantic Health System —Morristown, NJ
- Full-time
- Microsoft Excel
- Microsoft Access
- Mid-level
- 403(b) matching
- AD&D insurance
Claims Operations Analyst
EmpiRx Health, LLC —Montvale, NJ
- Full-time
- Research
- Office
- SQL
- Disability insurance
- Health insurance
Quick Apply
8d
Billing Analyst, Physician Billing
Hackensack Meridian Health —Hasbrouck Heights, NJ
- $30.92 an hour
- Full-time
- Mid-level
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
4d
Senior Quality Assurance Analyst
ASCOT GROUP —Iselin, NJ
- $110,000 - $120,000 a year
- Full-time
- Hybrid work
- Office
- Microsoft Office
- 3 years
- Health savings account
- AD&D insurance
Quality Assurance Analyst (Health Edge, Health Rules Payer)
MetroPlus Health Plan —New York, NY
- $85,000 - $95,000 a year
- Full-time
- Remote
- Customer service
- Mid-level
- 3 years
Insurance Product Development Analyst (General Liability/Commercial) (hybrid/remote)
Verisk —Jersey City, NJ
- Full-time
- Remote
- 18 years or older
- Research
- Mid-level
- Health insurance
- Paid time off
Senior Appeals Analyst - STD
Prudential —Newark, NJ
- $66,700 - $110,100 a year
- Full-time
- Customer service
- Research
- Mid-level
- Employee stock purchase plan
- Disability insurance
9d
Provider Configuration Analyst
MetroPlus Health Plan —New York, NY
- $85,000 - $95,000 a year
- Full-time
- Remote
- Computer Science
- 5 years
- Bachelor's degree
4d
Claims Review Analyst
EmblemHealth —New York, NY
- $48,600 - $83,160 a year
- Mid-level
- Analysis skills
- Bachelor's degree
Technical QA Analyst II
Judi Health —New York, NY
- $95,200 - $119,000 a year
- Hybrid work
- Computer Science
- Writing skills
- Mid-level
Quick Apply
Senior Analyst, Vendor Payment Integrity - Remote
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Oracle
- Master's degree
- Bachelor's degree
SERFF Filing Analyst II
Verisk —Jersey City, NJ
- Full-time
- Remote
- 18 years or older
- Mid-level
- 3 years
- Health insurance
- Paid time off
10d
Claims Administrative Analyst
MetroPlus Health Plan —New York, NY
- $65,000 - $70,000 a year
- Full-time
- Hybrid work
- Inventory management
- Mid-level
- Office
Business Analyst
Verisk —Jersey City, NJ
- Full-time
- Hybrid work
- 18 years or older
- Mid-level
- SQL
- Health insurance
- Paid time off

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claims analyst jobs near nutley nj

Claims Negotiation Analyst (Out of Network Mandates)

Horizon Blue Cross Blue Shield of New Jersey -
Newark, NJ

Apply Now

Job Details

Full-time
$58,029 - $77,074 a year

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

Foreign language proficiency
Correspondence management
Phone communication
Basic math
Client inquiry handling
De-escalation techniques
Medical claims processing software
High school diploma or GED
Typing
Productivity software
Customer interaction during outreach
Client interaction via phone calls

Full Job Description

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

The incumbent manages the resolution of out of network billing disputes for inadvertent and/or
involuntary out of network services in which Horizon BCBSNJ and the out of network health care
professional cannot agree upon reimbursement. The incumbent handles the negotiation
cases within the regulatory timeframes as mandated by the State and Federal regulations and be
required to maintain end to end oversight to bring cases to resolution.

What You'll Do

Job Responsibilities:

Timely and accurate creation and closure of Interactions and Intents and/or open negotiations via the SharePoint site including appropriate coding and updates related to mandate determinations and all applicable attachments for reporting purposes.
Completion of eligibility verification upon assignment of new mandated cases including validation services are in scope of the surprise bill mandate, appropriate mandate applies, minimum threshold amount met, non-initiating party met all regulatory timeframes for submission submitting accurate and complete forms.
Interacts with relevant parties to facilitate timely and accurate negotiation resolution.
Research and review of negotiation attempts including but not limited to pulling of phone calls, authorizations, outreach to providers/billing agencies and attorneys including validation of all information submitted as part of the dispute.
Updates to high dollar negotiation files including investigation and research to determine eligibility based upon on the negotiation request document.
Prepares written responses including negotiation outcomes by completing a written justification on how Horizon BCBSNJ adjudicated the initial and adjusted claim, but not limited to, benefits, contracts, payment and pricing methodology, proof of plan and providing explanation of benefits within regulated timeframes. Including the handling and response for Escalated complaints from CMS/DOBI/DOL and Legal/Litigation.
Accurate and timely adjustments based upon negotiation outcomes within the regulated timeframe including any applicable interest.
Conducting any follow up or additional research as deemed appropriate based upon negotiation requests.
Conducts detailed root cause analysis, including tracking and trending of errors and omissions that led to escalated complaints and make recommendations to avoid future occurrences.
Participate in staff meetings as deemed appropriate.
Creation of GSI’s and logging of cases on Blue 2 for ITS Home/Host cases requiring interaction with other Blue’s plans.
Perform other duties as required by management.

What You Bring

Education/Experience:

High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Requires five years of business experience which must include two+ years of correspondence and/or telephone customer service experience screening, investigating and examining inquiries
Experience in claims processing necessary
Ability to navigate the various claims and service operations systems
Healthcare industry experience helpful

Knowledge:

Knowledge of HBCBSNJ complaints and appeals process preferred.
Knowledge of insurance claim and membership systems preferred.
Knowledge of medical terminology, COB, Medicare procedures preferred.
Knowledge of UCSW preferred.
Knowledge of Claims Policy guidelines preferred.
Knowledge of Microsoft Office Suite required.

Skills and Abilities:

Requires the ability to understand and use language correctly, to be determined by the Language skills test.
The Employer may require an employee to pass an additional test(s) as a part of determining whether the applicant meets the minimum qualifications for the job.
Requires keyboarding proficiency.
Requires the ability to perform basic arithmetical calculations.
Requires the ability to read, understand and interpret written materials.
Requires the ability to apply reason in order to determine the appropriate arithmetical operation for solving a problem.
Requires the ability to analyze information and to understand and apply rules and procedures.
Requires the ability to compose business letters.
Strong verbal and written communication including the ability to clearly communicate technical information to all levels of internal management and external stakeholder. Must be able to detail member-specific issues through the development of individual correspondence for each case, explaining all issues in a comprehensive, understandable fashion.
Requires strong telephone/interpersonal skills, strong conflict resolution skills and the ability to remain professional during difficult interactions with customers.
Excellent interpersonal skills (i.e. active listening).
Strong research, investigative, analytical, decision making and problem solving skills.
Ability to perform in high pressure situations.
Ability to multitask.
Ability to manage and diffuse irate callers.
Time management skills.

Travel (If Applicable):

Some travel may be required.

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:

$58,029 - $77,074

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. 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.

Apply Now

Refine Your Search

claims analyst jobs in nutley nj

Claims Negotiation Analyst (Out of Network Mandates)

Medical Policy Analyst

Compliance Analyst

LOGISTICS ANALYST

Analyst, Customs and Trade Compliance – North America

CLAIM ADMIN-PRGM ANALYST

Financial Application Analyst II - Full Time - Days - Corporate

Claims Operations Analyst

Billing Analyst, Physician Billing

Senior Quality Assurance Analyst

Quality Assurance Analyst (Health Edge, Health Rules Payer)

Insurance Product Development Analyst (General Liability/Commercial) (hybrid/remote)

Senior Appeals Analyst - STD

Provider Configuration Analyst

Claims Review Analyst

Technical QA Analyst II

Senior Analyst, Vendor Payment Integrity - Remote

SERFF Filing Analyst II

Claims Administrative Analyst

Business Analyst

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