Operations Support Specialist II

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

Responsible for providing guidance and support to more junior staff and responding to audit inquiries for internal team members and outsourced staff. Function as a work leader to more junior staff and contribute to the development of learning solutions for Service Training delivery.

What You'll Do

Responsibilities:

• Provide guidance and support to more junior staff: conducting formal observations to assess junior coach performance and/or progress.
• Assist internal team members and outsourced staff in reviewing errors, responding to audit inquiries, and handle more complex work assignments.
• Participate in on-boarding, competency identification, execution of development plans, talent management, etc.
• Identify trends, recommend changes to processes including workflows, assess process deficiencies, and conduct one on one mentoring.
• Escalate system and operations issues reported to business owners or identified through analysis and assist with problem resolution.
• Produce daily educational bulletins to enhance quality.
• Collaborate with Training Quality and Operations during and after training period to ensure optimal learning experience, smooth post-training transition, on-going monitoring and training alternatives. Responsible for cross-training new/existing training at Horizon sites and at remote vendor locations
• May represent Operations unit at cross-functional meetings and work group sessions.
• Assist Supervisor with the modification of training resources/schedules in response to staffing issues and/or business needs.
• Monitor provisions and make recommendations to Service Level Agreements (SLAs) to ensure productivity and quality goals are met
• Work with business units in conducting gap analysis and/or review data/metrics to determine if training solution is needed and if so, what type is required.
• Participate in cross-functional meetings and work group sessions to identify improvement opportunities.
• Partner with stakeholders to develop and deliver learning solutions in support of new products, new/upgraded systems and business initiatives.
• Responsible for training and delivery at Horizon sites and at remote vendor locations.
• Collaborate with other Service Training & Development areas (Instructional Design & Knowledge Management) to provide input into learning solution program design and implementation.
• Serve as testers of workflows and processes of business/systems supported.
• Assist with inventory management
• May also be responsible for other T& D elements such as Instructional Design if performing this function in a specialized business unit.
• Perform other relevant tasks as assigned by management.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• 5 years experience in health insurance operations preferably in a related role.

Knowledge:

• Requires knowledge of current industry trends and Best Practices.

• Requires healthcare industry knowledge.

• Requires claims processing experience.

Skills and Abilities:

• Strong PC skills.

• Organizational, Multitasking, Analytical Thinking and strong Interpersonal and Presentation Skills.

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:

$63,000 - $84,420

​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.