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

Job Summary:

This position is responsible for ensuring compliance of all small group business in relation to Small Employer health and internal underwriting regulations by reviewing sales packages to ensure and verify completeness and accuracy of the content. Serves as resources representative for internal/external customers for Small Employer guidelines and internal underwriting regulations.Responsibilities:

• Reviews and monitors in-house and field written proposals, including an analysis of individual health applications, enrollment information and other significant in-house data to evaluate groups' overall compliance with current underwriting regulations in accordance with established guidelines.

• Reviews sales packages to ensure and verify completeness and accuracy of content as it relates to Small Group Reform.

• Notifies brokers and sales representatives of underwriting rules and regulations and Reform regulations as well as identifies incomplete applications and informs them of approvals and or denials of eligibility.

• Updates underwriting regulation manual with new or revised state and/or internal regulations.

• Conducts quarterly sales meetings to review quality metrics for trends and recommends changes.

• Develops materials and trains sales representatives and brokers on compliance rules and regulations.

• Identifies and advises sales supervisors of trends and errors to avoid potential fraud.

• Serves as resources representative for internal/external customers for Small Employer guidelines and internal underwriting regulations.

• Administers transition for mandatory conversions.

• Prepares monthly/quarterly quality reports.

• Completes other assigned functions as requested by Management.

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.

Education/Experience:

• High School Diploma/GED required.

• Requires minimum three (3) years of health insurance experience.

• Prefer experience in training capacity or with conducting formal presentations.

Knowledge:

• Requires knowledge of group health insurance industry.

• Prefers knowledge of Horizon products and underwriting policies.

• Requires working knowledge of personal computers and supporting software in windows based environment including MS Office Products and email application systems.

Skills and Abilities:

• Requires excellent oral and written communication skills.

• Communication & Organization

• Information/Knowledge Sharing

• Collaborative

• Attention to Detail

• Presentation

Salary Range:

$61,200 - $81,900

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

Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

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.