Arbitration/Disputes Analyst, Horizon Casualty Services

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.

• Maintain current knowledge of New Jersey Personal Injury Protection (PIP) and workers compensation rules and regulations.

• Act as a liaison between Horizon Casualty Services and its clients/adjusters.

• Manage litigation calendar and log.

• Review/verify the accuracy of medical bill payments in accordance with State regulations and provider contracts.

• Creates persuasive written arguments based on gathered supporting documentation.

• Negotiate settlements with plaintiff attorneys.

• Educate providers and attorneys on medical bill reimbursement guidelines in accordance with the contract and State regulations.

• Communicate with attorneys, providers and client adjusters.

• Track and trend issues and brings to resolution.

• Perform other duties as requested by Manager.

Education/Experience:

• High School Diploma/GED required
• Requires a minimum of three to five years of experience in NJ PIP.
• Experience in arbitration handling and claim handling preferred.

Knowledge:

• Requires working knowledge of the New Jersey Personal Injury Protection (PIP) rules and regulations, and PIP arbitrations.
• Requires understanding/knowledge of medical billing, coding and medical bill reimbursement.
• Must be proficient in the use of personal computers and Microsoft Office Products such as Word, Excel and PowerPoint.

Skills and Abilities:

• Must be proficient in the use of personal computers and Microsoft Office Products such as Word, Excel and PowerPoint.
• Requires excellent communication and negotiation skills.
• Requires excellent analytical and critical thinking skills.
• Must have the ability to work independently within the team, with minimal supervision
• Must have the ability to multitask.
• Must be detailed oriented and have strong organizational skills.
• Must be customer service oriented.
• Must be flexible, adaptive and decisive.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

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:
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.