Group Underwriter II

$76,800 - $102,795/Yr

Horizon Blue Cross Blue Shield of New Jersey - Newark, NJ

Full-time - Mid Level

Remote - Newark, NJ

Insurance Carriers and Related Activities

About the position

The Behavioral Health Network Specialist position is a critical role within the behavioral health network management team, primarily responsible for outreach, recruitment, and relationship management with behavioral health practitioners. This position is accountable for identifying and resolving issues while maintaining effective relationships with the provider community. The specialist will engage in proactive outreach to ensure that practitioners are informed about Horizon's products and services, and will work to influence the adoption of strategic initiatives aimed at improving efficiency and service quality. The role requires a thorough understanding of the healthcare industry, particularly the behavioral health sector, and the ability to analyze data to recommend actions that strengthen provider relationships. In this role, the specialist will analyze membership and geographical access to determine specific goals for recruiting new practitioners. They will also participate in the recruitment and maintenance of the behavioral health provider network, providing input on contract renewals to enhance service delivery. The specialist will be responsible for educating practitioners about Horizon's offerings and will engage in outreach to high-volume behavioral health groups to build rapport and ensure they are updated on relevant information. Additionally, the specialist will collaborate with other members of the BH network management team to troubleshoot complex claims and program disputes, alerting leadership to potential risks and opportunities identified through network interactions. They will also plan and present seminars to various stakeholders, maintain knowledge of industry trends, and identify cost-saving opportunities that enhance the quality of care. This position requires strong communication skills and the ability to drive collaboration across departments to ensure effective service delivery and project management.

Responsibilities

• Serve as the key external-facing member of the behavioral health network management team for the behavioral health professional network in their designated geographic area.
• Analyze membership and geographical access by BH Specialty to determine specific goals and action plans for targeted recruitment of new practitioners.
• Develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the behavioral health provider network.
• Provide input to behavioral health special payment arrangement contract renewals to improve services and maximize retention and initial provider enrollment.
• Inform and educate behavioral health practitioners on Horizon’s products and services, influencing network adoption of strategic efficiency initiatives.
• Engage in proactive outreach to high volume behavioral health groups to build rapport and ensure providers are aware of pertinent updates.
• Analyze provider-related information and data to recommend actions and solutions to strengthen provider relationships with Horizon.
• Initiate communication with other members of the BH network management team to troubleshoot complex claim situations and program/policy disputes.
• Alert leadership to potential issues, risks, and opportunities identified through behavioral health network interactions.
• Plan, organize, and present seminars to various BH network practitioners and groups, billing services, medical societies, and internal groups.
• Maintain thorough knowledge of healthcare industry trends and developments through industry publications and formal training.
• Identify, research, recommend, and implement potential saving opportunities for cost-effective and quality care delivery.
• Facilitate dialogue with BH Network Leadership and practitioners regarding practice patterns and BH quality/outcomes measures.
• Drive communication with staff and managers to ensure interdependencies between departments are accurately identified and addressed.

Requirements

• High School Diploma/GED required.
• Bachelor's degree preferred or relevant experience in lieu of degree.
• Minimum of five (5) years healthcare experience, preferably with provider or client focus/interaction.
• Behavioral health related experience in the healthcare/insurance industry preferred.
• Knowledge of the healthcare industry is required.
• Knowledge of the New Jersey behavioral health provider community is required.
• Knowledge of HBCBSNJ programs, products, and procedures preferred.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement