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
This position is responsible for independently analyzing and having oversight for the analysis and translation of business needs into business/technical requirements. Leads and coordinates teams of other resources to ensure alignment of technical solutions with business requirements for complex issues/projects (quantity and magnitude). Conduct requirements interviews with stakeholders to capture and validate information provided in elicitation sessions and Joint Application Development (JAD) sessions. Support the translation of business requirements into the estimation and business case development process. Subject matter expert in using tools and methodologies (e.g. SIPOC) to identify process and operational efficiencies in business current and future state models.
What You'll Do
Serve as the primary Business Systems Analyst for Blue Card, BlueCard Modernization (BCM), National Program Releases (NPR), Inter-Plan Teleprocessing System (ITS), Blue2, BlueCard Portal, RTM, and related BCBSA initiatives.
Leads and owns the analysis of complex issues/projects.
Coordinates the documentation of business needs including understanding and documenting business process flow documents.
Transitions the requirements and user stories to designers/developers and ensures a clear and complete understanding of the requirements.
Oversees the creation of technical documents, high level solution designs, development, testing and implementation of system specifications, when required. Acts as Subject Matter Expert in systems and technologies and recommends best practices for delivering business solutions.
Analyze BCBSA, NASCO, and Horizon requirements to identify business, operational, and technical impacts across Host and Home claims processing environments
Manages the process for identifying stakeholders and ensuring requirements across the project portfolio align to the enterprise and business unit strategy.
Manages the appropriate use of various analysis techniques to requirements and the organization, including the synthesis of large amounts of information provided by stakeholders, to identify opportunity for improvements.
Manages a diverse set of stakeholders and integrated complex current state structures to effectively optimize the future state process; understanding organizational culture, structure and impact on the business capabilities.
Lead requirement elicitation, impact assessments, and solution design discussions with business stakeholders, NASCO, BCBSA, and internal technology teams
Coordinate and facilitate reviews of BRDs, CSRs, TRDs, user stories, and functional requirements to ensure alignment with enterprise standards and BCBSA Mandates.
Partner with NASCO, BCBSA, and cross-functional teams to evaluate release enhancements, regulatory changes, and modernization initiatives impacting Blue Card operations.
Provide subject matter expertise for Host/Home claim processing, Inter-Plan Programs, ITS, Blue2, Real-Time Messaging (RTM), and BlueCard Modernization initiatives.
Develop and manage traceability from requirements through testing, implementation, and post-production validation.
Support SIT, UAT, Model Office, and production validation activities by creating test scenarios, reviewing test cases, coordinating defect resolution, and obtaining business sign-off.
Lead cross-functional impact assessments involving Claims, Operations, Provider Services, Middleware, Data Management, Analytics, Payment Integrity, Process Automation, and external vendor teams.
Monitor and manage production issues, defects, and enhancement requests, ensuring timely resolution and stakeholder communication.
Represent Horizon in NASCO, BCBSA, Blue Card user groups, Workgroups, certification activities, and release readiness reviews.
Develop executive summaries, status reporting, risk assessments, and stakeholder communications for BCBSA initiatives.
Mentor junior analysts and provide guidance on Blue Card business processes, requirements management, testing strategies, and production support best practices.
What You Bring
Education/Experience:
Bachelor's degree required or 12 years of relevant experience in lieu of degree.
At least 8+ years of related information technology work experience, preferably in the health insurance industry.
Demonstrated experience in a key lead role in major company initiatives and demonstrated leadership experience.
Expertise leading Production Support activities including Issue resolution and bug fixing, application monitoring and dashboard tracking, Incident management and troubleshooting, Process improvements and Automation.
Knowledge, Skills, and Abilities:
Requires knowledge of system development life cycle and implementation methodologies.
Requires working knowledge in structured query languages or analysis techniques.
Demonstrates a basic ability to apply structure to a loosely defined problem.
Demonstrates a basic understanding of core business functions.
Prefers knowledge of Healthcare industry.
Requires strong interpersonal skills including the ability to collaborate with and lead teams.
Requires skillful project execution experience and knowledge in a lead role.
Requires ability to multitask and handle multiple projects simultaneously while supporting others.
Requires excellent verbal and written communication skills along with skill at building rapport, active listening, and reading the underlying dynamics of the group and presenting to internal and external leadership.
Requires fundamental critical thinking and problem-solving skills with the ability to mentor lower level BSAs on critical thinking and problem solving.
Requires strong PC skills including MS Office Suite and Visio.
Requires working knowledge of programming, development, and technical architecture with knowledge of specific technologies in scope of primarily supported applications.
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:
$109,600 - $149,625
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.