Hcc Risk Adjustment Coder Jobs in New Jersey (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 role supports actuarial and data analytics for risk-adjusted business across ACA, Medicare Advantage, and Medicaid. Responsibilities include analyzing risk scores, financial impacts, and performance metrics, as well as developing insights to guide risk adjustment strategy, reporting, and pricing/forecasting efforts. The position requires strong analytical skills and the ability to translate data into actionable business recommendations.

What You'll Do

• Perform or support actuarial analytics on risk adjustable lines of business, including ACA, Medicare Advantage, and Medicaid.

• Perform or support CMS-HCC and HHS-HCC risk score projections, including RATP, MA MYRA/FYRA accruals, and RADV financial impacts.

• Perform or support data analytics and reporting to inform risk adjustment operations, strategy, submissions, and vendor performance.

• Perform or support financial metrics pertaining to risk adjustment performance, including but not limited to intervention ROI.

• Collect and analyze data to use for financial and utilization reporting and monitoring.

• Support pricing and forecast efforts, including ACA pricing and MA Bid submissions.

What You Bring

Education/Experience:

• Bachelors degree is required, preferably within Mathematics, Statistics, Actuarial Sciences or a related field from an accredited college or university.

• Requires 2+ years of actuarial and/or statistics experience or attainment of Associate level in the Society of Actuaries (ASA).

Additional licensing, certifications, registrations:

• ASA candidate a plus.

Knowledge:

• Requires working knowledge of Excel.

• Prefers experience with SAS or other programming language.

• Prefers knowledge of data analysis and Actuarial principles.

Skills and Abilities:

• Requires good oral and written communication skills.

• Requires strong analytical thinking.

• Requires strong mathematical skill and statistical analysis abilities.

• Requires good judgment and problem solving skills.

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:

$79,100 - $105,945

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.