Business Systems Analyst IV (Benefits Coding)
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 analyzing, understanding and translating business needs into product and benefits requirements. Leads and coordinates teams of other resources to ensure alignment of technical solutions with business requirements for medium to complex issues (quantity and magnitude).
What You'll Do
Lead the process of identifying and recommending coding solutions for enterprise projects and complex benefit coding problems
Validate and approve business requirements
Understand Mandates, Product Development coding grids and BRDs and interpret what is required for benefit updates
Create and deliver work estimates to Project Managers
Document project one-pager dashboards with schedule, budget, blockers, progress
Assist with claims testing scenarios
Document standard operating procedures
What You Bring
Education/Experience:
High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Graduate studies or professional development activities preferred
6-8 years of related IT work experience preferably in the health insurance industry
Demonstrated experience in a key role in major company initiatives and demonstrated leadership experience
Needs strong product and benefit knowledge
Prefer experience in benefit coding via HRBK (Via NASCO) or Benefact.
Needs strong claims processing skills
Special Licensing or certifications:
Preferred Business Analyst Certification
Knowledge:
Requires knowledge of system development life cycle and implementation methodologies
Requires excellence in structured query languages, or analysis techniques
Requires strong ability to apply structure to loosely defined complex problems
Demonstrates understanding of core business functions
Needs strong communication skills
Needs strong problem solving and analytical skills
Prefer procedure, diagnostic code knowledge
Skills:
Requires skillful project execution experience and knowledge
Requires excellent verbal and written communication skills
Requires knowledge of programming, development, and technical architecture
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:
$97,800 - $133,455
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.
Apply To This Job
About the Role
This position is responsible for analyzing, understanding and translating business needs into product and benefits requirements. Leads and coordinates teams of other resources to ensure alignment of technical solutions with business requirements for medium to complex issues (quantity and magnitude).
What You'll Do
Lead the process of identifying and recommending coding solutions for enterprise projects and complex benefit coding problems
Validate and approve business requirements
Understand Mandates, Product Development coding grids and BRDs and interpret what is required for benefit updates
Create and deliver work estimates to Project Managers
Document project one-pager dashboards with schedule, budget, blockers, progress
Assist with claims testing scenarios
Document standard operating procedures
What You Bring
Education/Experience:
High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Graduate studies or professional development activities preferred
6-8 years of related IT work experience preferably in the health insurance industry
Demonstrated experience in a key role in major company initiatives and demonstrated leadership experience
Needs strong product and benefit knowledge
Prefer experience in benefit coding via HRBK (Via NASCO) or Benefact.
Needs strong claims processing skills
Special Licensing or certifications:
Preferred Business Analyst Certification
Knowledge:
Requires knowledge of system development life cycle and implementation methodologies
Requires excellence in structured query languages, or analysis techniques
Requires strong ability to apply structure to loosely defined complex problems
Demonstrates understanding of core business functions
Needs strong communication skills
Needs strong problem solving and analytical skills
Prefer procedure, diagnostic code knowledge
Skills:
Requires skillful project execution experience and knowledge
Requires excellent verbal and written communication skills
Requires knowledge of programming, development, and technical architecture
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:
$97,800 - $133,455
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.
Apply To This Job