Vendor Relationship Admin

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

Job Summary:

Responsible for managing the relationship and operations between Horizon-BCBSNJ and the delegated vendor for services as defined by contract. This includes conducting a review of vendor activities and providing direction to ensure performance is met in the areas of customer satisfaction, claims processing, network management, utilization management, performance guarantees for Horizons ASO clients training of internal stakeholders and provider network, and other delegated requirements as determined.

Responsibilities:

• Accountable for management of delegated vendor operations and processes, the methods/workflows defining how the delegated vendor aligns with Horizon's core business processes including key contact for all interactions between delegated vendors across divisions within Horizon.
• Review and direct vendor activities, ensuring performance meets service level goals and other terms and conditions are met.
• Monitors service provider operations and performance against service level agreements, examines measured results for problem determination and root cause analysis, and takes appropriate action to correct failed activities, functions and processes.
• Informs vendor changes to state (New Jersey, New York) and federal laws, NCQA, URAC, mandates established by Departments of Health, Insurance and Labor, and regulations for continuous compliance.
• Review, develop and recommend processes to improve and/or enhance vendor operations and performance in the areas of call handling, claims processing, enrollment verification, billing practices and information systems utilization as well as decrease administrative costs.
• Ensures delegated vendors and internal stakeholders are adhering to delegated program. Ensures vendor compliance with laws, mandates and regulatory agencies as required. Conducts and coordinates comprehensive audits.
• Identifies and tracks industry trends relating to delegated vendor programs, financial and/or compliance risks, program issues that are impacting delegated vendor services from achieving performance goals and present resolution and improvement opportunity to Horizon Leadership.
• Creates, negotiates and incorporates contract amendments, re-negotiating if required, to accommodate scope changes.
• Reviews contract budget variances and takes corrective action as needed.
• Serves as first point of contact to resolve contractual related issues and vendor disputes.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Education/Experience:

• Requires Bachelors degree from an accredited college or university, preferably in Business Administration field.
• Requires a minimum of 5 years experience in finance or contract/ vendor management field or relevant field preferably in health insurance.

Additional licensing, certifications, registrations:

• Requires valid drivers license.

Knowledge:

• Requires knowledge of contracting concepts.
• Requires knowledge of the regulatory environment, New Jersey and New York health insurance laws, mandates and regulations.
• Requires knowledge of auditing procedures.
• Requires knowledge of the managed care and health insurance industries.
• Requires knowledge of Horizon-BCBSNJs products and services.

Skills and Abilities:

• Requires strong interpersonal skills.
• Requires strong verbal and written communication skills.
• Requires excellent analytical skills.
• Requires the ability to effectively interface with all levels of management.
• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.
• Requires demonstrated ability in problem solving.

Travel % (If Applicable):

• Requires up to 20% travel as needed.

Salary Range:

$106,400 - $145,215

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.