Horizon Blue Cross Blue Shield of New Jersey · 20 hours ago
Process Auditor I
United States
Full-time
Remote
Entry Level
$45K/yr - $60K/yr
1+ years expHorizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and has been a health solutions leader for over 90 years. The Process Auditor I role focuses on ensuring excellent customer service by responding to inquiries from hospitals and ancillaries, resolving overpayments, and researching claims in accordance with company policies.
Health Care
Responsibilities
Provide resolution to identified overpayments utilizing various methods i.e., written correspondence, outbound call, or adjustment to a claim
Research/adjust claims (i.e., Coordination of Benefits, no-fault, claim policy, authorizations, and referrals) in accordance with Plan contract provisions and all other governing policies and/or procedures
Research and resolve Accounts Receivable (AR) issues to include the disposition of Cash Receipts in Universal Payment System (UPS)
Ensure accurate and timely resolution of service requests and activities is provided in accordance with the customer's health benefit coverage and company policy
Anticipate and resolve potential issues and follow through on commitments made to the customers
Coordinate with other areas within and outside of Service to address customers' inquiries regarding claim payment, benefits and/or appeals
Follow up on unresolved issues via outbound calls, emails or faxes
Share knowledge and information willingly with team members to achieve team, division, and Enterprise goals while enhancing service quality
Submit provider file updates as appropriate
Receive inbound telephone calls as they relate to recovery efforts
Perform other related tasks as assigned by management
Qualification
Required
High School Diploma/GED required
1 to 2 years customer service/benefit processing experience
Strong PC skills
Analytical thinking
Strong written and verbal communication necessary
Preferred
Strong knowledge of Medical terminology preferred
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
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