Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

The Tax Analyst I is accountable for assisting with the compliance of federal, state and local tax laws and is accountable for the filing of assigned federal and state income, premium, franchise and other tax returns. This position will contribute to the company's payroll tax compliance as well as Federal & State tax laws. This position will also ensure compliance with th

The Cyber Security Analyst II supports a 24/7/365 Security Operations Center (SOC) and provides 2nd Tier analysis and response to security events. Actively prepares for, and hunts for, malicious internal and external threats as a part of our cyber incident response program in the Security Operations Center (SOC). CSA II will analyze malware, emerging threats and emerging

Responsible for managing multiple aspects of the Enterprise medical costs structure including both on system and off system medical costs and directly lead efforts across the Enterprise to provide and present meaningful medical cost trend analysis to drive opportunities and decision making. Collaborate with multiple Commercial and Government Program business partners, inc

This position is accountable for the conservation of existing accounts and selling additional product lines where appropriate and profitable for the SHBP, Public, and Jumbo markets. This position as it functions in the Labor market will be accountable for servicing of existing accounts as well as selling new business. Manages contract renewals and ensures services are pro

This position is responsible for the pick up and delivery of mail and supplies between Horizon buildings and U.S. Post Office. This position will also be responsible for commuter and passenger van services. Drives the van between all Horizon locations and picks up/delivers mail and supplies. Monitors the workflow of mail receivables throughout the unit. Loads and unloads

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

The Manager of Clinical Analytics is a managerial position requiring excellent leadership, communication, and data analytics technical skills. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to support clinical performance analytics, development, and reporting that deliver actionable clinic

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

The Medical Economics Consultant provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. This role will be responsible for the design and development of reports to monitor product performance and identify the root causes of medical cost trends. Responsi

The Analytics Analyst III will partner with multiple customers to provide more complex resolutions to analytics/data problems (i.e. linear models, pattern analysis, directional modeling, etc.) that require a more detailed and deeper study of situational factors, gathering information from several sources, and providing reporting analysis deliverables (i.e. tables, visual

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out clinical analytics. The position is a key team member collaborating in a multi disciplinary business environment with colleagues across the enterprise to lead clinical performance analytics, development, and reporting that deliver actionable clinical insights to

Reporting directly to an Audit Manager, responsibilities include developing the scope of audits, programs or initiatives, executing testing and reporting in a quality manner, and the identification as well as tracking of issues to closure. Responsibilities Executes assigned planning, data gathering, analysis and testing tasks independently and in the timeframe established