Member Management Coord

Role Summary

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.

The COB (Coordination of Benefits) Member Management function will be solely accountable for maintaining COB files and specifically ensure member data is kept consistent, accurate and current for the enterprise.

Knowledge

• Basic medical terminology and medical billing coding required.
• Perfered Knowledge of QBLUE, NASCO & UCSW systems
• Coordination of Benefits Rules & Regulations

Responsibilities

• Load and maintenance of member COB files
• Perform outreach to members to obtain COB information (LOI-s, phone calls, written correspondence etc).
• Resolve COB customer inquiries received via phone, fax, mail, e-mail, UCSW(Universal Customer Service Workstation), NASCO worksheets etc. in accordance with prescribed departmental process.
• Review & investigate computer systems and/or reference materials to complete COB verification based on the nature of the inquiry (member information, enrollment, etc.).
• Handle and respond to written COB correspondence
• Accurately document customer inquiries and actions taken in accordance with departmental guidelines to ensure appropriate follow up.
• Identify & escalate COB trends and root cause analysis of COB issues/problems to management in a timely fashion.
• Retrieve & analyze COB reports and perform corrective actions as necessary.
• Deliver an excellent customer service experience while meeting quality, production & timeliness standards.
• Communicate COB corrective actions with vendors, groups, sales or brokers as necessary.
• May participate in hospital and physician workshops on COB.
• May perform COB testing during implementation/upgrade of claims/customer service systems.
• Perform other relevant tasks as assigned by management.

Requirements

Core Individual Contributor Competencies

1. Personal and professional attributes that are critical to successful performance for Individual Contributors:
2. Customer Focus
3. Accountable
4. Learn
5. Communicate

Education/Experience

1. Prefers a bachelor's degree from an accredited college or university.
2. Requires a minimum of two years customer service experience perferrable in the health insurance industry.
3. Requires customer service experience in the research, investigation and resolution of problems and/or complaints.
4. Requires prior experience with PC's and related software applications.

Skills and Abilities

1. Excellent Customer Service skills
2. Ability to work in a high pressure, fast-paced environment.
3. Keyboarding proficiency.
4. PC proficiency.
5. Strong verbal and written communication skills.
6. Presentation skills.
7. Strong interpersonal skills (i.e., active listening).
8. Investigative and analytical skills.
9. Ability to multitask.
10. Time management skills.
11. Flexibility and adaptability.
12. Ability to work effectively within a team environment.
13. Needs to demonstrate the willingness to be cross trained in other duties

$47,961 - $63,820

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

Travel (If Applicable)

• Internal travel may be required.

About the Company

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!

Additional Information

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.