NJM Insurance Group

Consultant

• Key member of account management team in its efforts to sell new business, inclusive of ancillary products
• Create and facilitate client presentations and meetings, utilizing anaylsis of current client trends and plan design offerings
• Analyze data to recommend changes and cost saving designs incorporating medical management programs
• Responds timely and proactively to account or broker telephone inquiries
• Must build strong internal and external relationships
• Resolves complex service issues, and answers product and benefits questions
• Assists in processing paperwork relating to the prospecting, enrollment, and/or termination of accounts
• Maintains the accuracy of the account profile and group administration through data updates
• Facilitates and coordinates the timely implementation of new groups and conversions
• Analyzes inter-departmental problems and makes recommendations for resolutions.
• Assists in the procurement of information from groups to complete and verify sale documentation.
• Responsible for reporting requests and confirming data accuracy.
• Performs other duties as assigned by management.

Account Consultant II

Pharmacist

• Responsible for all telephonic interaction with members, physician office staff, pharmacies and internal stakeholders for Pharmacy eligibility, coverage determination, and/or claim issues
• Engagement with physicians & pharmacists to conduct effective interventions through clinical therapeutic interchange to facilitate formulary compliance, optimize generic dispensing, and consistency with the current plan design
• Capture accurate and comprehensive clinical information for Prior Authorization requests from physicians and/or medical office staff to allow for clinical review and medical necessity determination
• Responsible for satisfying all departmental customer service quality metrics while ensuring that all DMAHS and DOBI required regulatory turnaround times are consistently satisfied
• Process complaints, appeals, grievances, executive inquiries and compliance related issues
• Responsible for identifying via interactions with members and providers, instances of potential fraud, waste, and abuse and resulting internal referrals that are necessary
• Provide recommendations to increase efficiency, accuracy and productivity in the department
• Process ad hoc request for information or reports from stakeholders
• Accountable for independent and group learnings to ensure understanding of pharmacy services procedures and workflows
• Assist in the day-to-day business functions of the pharmacy department as well as the Medication Therapy Management program
• Provide support to various clinical programs within the pharmacy department

Pharmacy Specialist I

Security Engineer

• Define, lead, and manage all aspects of the Third Party Risk Management (TPRM) Program.
• Identify, document, and communicate security risks and control deficiencies to business and IT stakeholders, driving awareness of emerging and relevant risks across Horizon BCBSNJ’s third-party landscape.
• Establish and maintain third-party privacy and security policies and standards, and oversee program effectiveness through measurement, governance, and continuous improvement.
• Serve as the primary information security risk interface to leadership teams, providing strategic guidance and insight on third-party and enterprise risk exposures.
• Direct and manage the Information Security Risk Management (ISRM) program, including team leadership, budget planning, resource allocation, and development of enterprise risk metrics and reporting.
• Ensure IT project risk assessments, application security reviews, and vendor risk assessments are integrated into the eGRC platform to support compliance with corporate information security policies and standards.
• Act as a trusted advisor to business stakeholders by maintaining ongoing awareness and alignment on identified and emerging risks.
• Partner with Internal Audit, Corporate Compliance, Office of General Counsel, and Risk Management to remediate identified issues, and track security-related findings within the eGRC system.
• Provide subject matter expertise and security risk consulting for third-party contracts (MSAs, BAAs, SOWs) and hosted services (SaaS, PaaS, IaaS) across all Strategic Sourcing engagements.
• Serve as the liaison to Enterprise Risk Management (ERM) for technology and cybersecurity risks, including collaboration on annual risk quantification for Horizon BCBSNJ’s Own Risk and Solvency Assessment (ORSA).
• Collaborate with the Director of Information Security and key stakeholders to enhance eGRC program procedures, controls, and the overall ISRM framework.
• Lead and manage security initiatives that address identified risks and business requirements, ensuring compliance with regulatory, legal, and industry best practices.

Senior Manager, Cybersecurity Risk

Human Resources

• Serve as a senior-level advisor to executives and business leaders, providing guidance on workforce planning, organizational strategy, team effectiveness, and leadership capability.
• Deeply understand the business’s goals, operating model, and challenges to develop integrated people solutions that accelerate performance.
• Use analytics, trend data, and insight-driven decision-making to proactively identify opportunities and mitigate risks.
• Lead organizational design efforts, including structure assessments, capability mapping, role clarity, and change impact analysis.
• Partner with business leaders to forecast talent needs and ensure the workforce is aligned to short- and long-term business plans.
• Drive the talent lifecycle, including succession planning, performance management, leadership pipeline development, and high-potential identification.
• Provide advanced guidance on complex employee relations matters, partnering with Legal and Employee Relations as needed.
• Collaborate with Centers of Excellence (COEs) such as Talent Acquisition, Total Rewards, Inclusion, Opportunity & Talent Development, and HR Operations to deliver seamless HR solutions.

Senior HR Business Partner

Business Operations

• Conducting data collection and analyses to support process improvement programs and projects
• Leading a variety of initiatives, ranging in complexity and scope, within business divisions
• Drafting and reviewing project deliverables and analyses such as value-stream mapping and statistical analyses
• Supervising business process analysts in the project team environment
• Developing business cases using ROI models in direct relationship to strategic corporate goals
• Interacting with subject matter experts to develop solutions that improve process performance
• Planning and participating in BPI organization building and activities to help promote the BPI brand

Senior Business Process Engineer, Process Design Specialist

Account Manager

• Manages contract renewals and ensures services are provided that will maximize the potential for account retention and initial member enrollment
• Majority of account management and sales are via phone call and emails.
• Ensures proper installation of new accounts as well as changes to existing accounts.
• Plans and negotiates terms and conditions of contracts with existing accounts.
• Sells additional lines of business to existing clients.
• Compares and evaluates various products to make appropriate recommendations based on client needs assessment.
• Modifies existing contracts that require term changes that may be outside of predetermined guidelines or standards.
• Develops and conducts workshops for clients/groups relative to enrollment, claim procedures, and health industry regulations.
• Ensures that all accounts are promptly informed of relevant legislative and regulatory issues and their associated impact.
• Performs other duties as assigned by management.