Contractual Actuarial Programmer Jobs (NOW HIRING)

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 will assess incoming data from RA vendors and calculate financial penalties based on contractual performance. The analyst will also support contract negotiations through cost analysis, ROI estimation, and budget forecasting. This role will perform credit/reimbursement true up analyses at the finalization of projects.

What You'll Do

• Develop new approaches and improvements to validate, collect, and organize vendor data using Visual Basic for Applications (VBA).

• Provide complete and accurate information for vendor audits (ex. from Vendor Delegation Oversight).

• Respond to ad-hoc request from business stakeholders.

• Serve as a subject matter expert on vendor analytics (cost, quantity, services, contract (terms, timelines, deliverables) and performance (SLA & Penalties).

• Review and validate all invoice submissions to ensure alignment with contractual agreements.

• Assess the quality, timeliness, and completion of incoming data from risk adjustment vendors and calculate financial penalties based on contractual performance.

• Support vendor contract negotiations through cost analysis, ROI estimation, and budget forecasting.

• Assist with contract negotiation, analyze contractual requirements, identify contract deficiencies and recommend changes.

• Provide detailed analysis for PO requests and/or addendums.

• Perform credit/reimbursement true up analyses at finalization of vendor projects.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree in Accounting, Finance, Mathematics, Statistics, Economics, Actuarial Science or other analytical field preferred or relevant experience in lieu of degree.

• Requires a minimum of 4 years' experience in accounting.

Additional licensing, certifications, registrations:

• CPA preferred.

• Knowledge of accounting entries/accruals/month-end close process.

Skills and Abilities:

• Experience working in Excel, Visual Basic for Application (VBA) programming is a plus.

• Experience with Enterprise Resource Planning (ERP) systems (Workday).

• Experience with Billing/Purchasing/Procurement.

• Medicare, Medicaid, or commercial risk adjustment experience is a plus.

• Experience programming in SAS/SQL a plus.

Why Horizon?

At Horizon, you'll do meaningful work that directly improves lives-while being supported by a missiondriven 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:

$70,500 - $94,395

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.