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AI Summary

The role involves supporting Medical Cost Action Plan evaluations by analyzing health insurance claims and patient utilization data. You will collaborate with stakeholders to track medical expenses, identify financial leakage, and develop actionable cost-containment initiatives.

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 entry-level analyst position resides within the Actuarial Department and is primarily responsible for supporting the development, enhancement, and maintenance of the Medical Cost Action Plan evaluations (MCAPs). The role partners with stakeholders throughout the organization to analyze health insurance claims and patient utilization data to track actual medical expenses against budgets, identify specific financial leakage points, and design actionable cost-containment initiatives.

What You'll Do

  • Perform and support Medical Cost Action Plan evaluations across multiple lines of business.
  • Assist with forecasting and predictive modeling activities.
  • Collect, analyze, and interpret data for financial, utilization, and actuarial reporting, including IBNR monitoring and analysis.
  • Collaborate with business partners and stakeholders to understand reporting needs and provide actionable analytical solutions.
  • Develop innovative approaches to analyzing and visualizing data to drive informed business decisions.
  • Assist with ad hoc actuarial and analytical projects as assigned.

What You Bring

Education/Experience:

  • Bachelor's degree required, preferably in Actuarial Science, Mathematics, Statistics, Data Science, Economics, or a related quantitative field from an accredited college or university.
  • Master's degree is a plus.
  • Zero to two year of actuarial, statistical, healthcare analytics, or related experience required.
  • Successful completion of at least one Society of Actuaries (SOA) actuarial exam required.
  • Progress toward an actuarial credential (ASA) is preferred.

Additional licensing, certifications, registrations:

  • ASA candidate a plus.


Knowledge:

  • Working knowledge of Microsoft Excel required; familiarity with Microsoft Access preferred.
  • Experience with SAS, SQL, R, Python, or similar programming and data analysis tools required.
  • Basic understanding of actuarial concepts, statistical analysis, and healthcare data preferred.
  • Knowledge of medical claims, healthcare utilization, and medical terminology is a plus.
  • Strong analytical and critical-thinking skills with a high level of attention to detail.
  • Strong mathematical and statistical problem-solving abilities


Skills and Abilities:

  • Effective verbal and written communication skills, with the ability to present information clearly to diverse audiences.
  • Ability to learn quickly, manage multiple priorities, and work both independently and collaboratively.
  • Demonstrated sound judgment and problem-solving capabilities.

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:

$70,500 - $94,395

​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.

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