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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 is responsible for vendor management, performance measurement, and analytics for Enterprise Risk Adjustment. Drives strategy, ensures accurate KPI reporting, and partners cross-functionally to optimize vendor and operational performance across Commercial, Medicare, and Medicaid programs. What You'll Do
Job Responsibilities:
Develop and lead risk adjustment vendor strategy aligned to enterprise goals
Identify vendor needs, source and evaluate partners, and define success measures
Negotiate contracts and own day-to-day vendor relationships
Lead RFPs, vendor selection, implementation, and offboarding
Manage onboarding and wind-down activities including data retention and destruction
Ensure effective transition and integration of vendor services
Design and maintain KPI frameworks for vendors and internal operations
Develop models and reporting to measure financial impact and operational outcomes
Analyze performance trends and identify improvement opportunities
Audit internal and vendor reporting for accuracy and completeness
Ensure data integrity and adherence to measurement standards
Support compliance and internal control requirements
Monitor vendor spend, billing, and budget performance
Develop forecasts and provide financial insights to leadership
Advise on budget risks and mitigation strategies
Review and reconcile vendor invoices to ensure accurate and timely payment
Partner with enterprise leaders to define targets and corrective actions
Present insights and recommendations to executive stakeholders
Mentor and guide analytics and reporting teams
What You Bring
Education/Experience :
Bachelor’s degree preferred in business, finance, statistics, healthcare, or related field.
6+ years healthcare or insurance experience with analytics/reporting.
3+ years supervisory experience.
Knowledge:
Extensive knowledge of risk adjustment and vendor performance management.
Strong analytical and statistical modeling skills.
Experience developing KPIs and performance frameworks.
Advanced Excel proficiency.
CPA or CMA certification preferred.
Experience with SAS, R, or SQL preferred.
Experience in ACA, Medicare, or Medicaid risk adjustment programs preferred.
Skills and Abilities:
Vendor Management
Risk Adjustment Analytics
KPI Development
Financial Modeling
Contract Negotiation
Data Analytics
Stakeholder Management
Regulatory Awareness
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:
$109,600 - $149,625 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.
