Job Description:

Job Summary:

Responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. Resolves issues and improves operational performance on a cross-functional/departmental basis. This is a senior level position working independently with guidance only in the most complex situations.

- Investigate service related issues to identify root cause of issues; identify and communicate business needs assessments as necessary.
- Develop forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)
- Translate business requirements and assist IT with the development of technical specifications.
- Develop solutions based on data analysis to increase business efficiency.
- Lead or participate in internal and external project workgroup(s) and presentations.
- Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
- Prepare materials for internal and external audit activities; review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective action steps.
- May coach/mentor less experienced staff, assist in on-boarding of new staff and/or distribute and follow-up on work assignments.
- Perform other relevant tasks as assigned by management.

ADDENDUM FOR QUALITY AUDIT MEASUREMENT TEAM ANALYSTS
-Identifies process improvement opportunities for platform work as an example, review SQM and QA reports, review trends to identify process improvement and automation)
-Gather, process FCR and QA performance data and conduct trending and root cause analyses
-Design and develop standard reports for metrics reporting and analysis. Document call center processes using standard techniques.

Education:
- Bachelor's degree required.


Experience:
- Minimum of seven (7) years' experience in an operational role, or analytical role

Knowledge:
- Knowledge of Healthcare industry required
- Knowledge of Project Management methodologies
- May require knowledge of Horizon Blue Cross Blue Shields products and services
- May require working knowledge of division operating plan and Horizon operating model.

Travel:
- Some travel may be required.
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.

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