This role is responsible for the cross-functional oversight for vendor claims, administrative appeals resolution, operational processes, claims inventory and timeliness, claim rejections and denials across multiple departments within Government Programs Operations.
Provide data driven solutions in coordination with internal and external business partners that demonstrate improvements in population health and overall cost; health economic evaluation; external health partner performance; and population-based clinical, financial and quality performance of various business programs and services.
Develop and manage initiatives for specific b2b and b2b2c programs/campaigns in direct marketing, advertising, promotion, special events, collateral, web site and other means that convey a unified and distinctive leadership presence in the marketplace.
Represents the Plan with external customers, providers and external agencies and represents the unit on corporate issues; manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
This includes gathering and prioritizing product and customer requirements, defining the roadmap, and working closely with sales, marketing, health affairs, operations, finance and other operational areas to ensure business goals are achieved throughout the Government Programs (GP) products lifecycle.
This senior level position is responsible for analyzing, understanding and translating data acquired through digital and direct marketing campaigns to produce insights that help steer the business decision-making process.
Responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence; perform appropriate analysis on data: forecasting, modeling, regression.
Leverage insights from the dashboards to consult with business owners, disseminate results, and build action plans; support Horizon BCBSNJ employee engagement initiatives, including employee training efforts.