Quality Program Manager Visa Sponsorship Jobs in New Jersey

INTRODUCTION

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

The primary responsibility of this position includes oversight of multiple billing and enrollment teams, ensuring that we deliver timely and accurate bills and enrollment completion to our customers, in addition to properly reporting revenue. This position is responsible for managing the account receivables and invoice reconciliation process, responding to internal and external regulatory audits, payment posting re-allocation, premium collection effort and manual and electronic enrollment in addition to managing high profile account delinquency and recouping and collecting premium payments. Execute monthly, quarterly and yearly revenue reports and partner with Finance on premium and general ledger tasks. Responsible for month-end, quarterly and year-end financial close for commercial and all fully insured group accounts. This role is accountable for the yearly rate renewal process and quality controls for the Medigap population while overseeing Medicare billing and premium rate validation process. This responsibility is accountable for the revenue and premium collection process for the commercial market where the annual revenue exceeds $4B.

• Continuously evaluate and analyze business processes and workflows to identify opportunities for operational improvement, increased efficiency, and cost reduction.
• Lead process improvement initiatives through root cause analysis, technology assessments, and workflow optimization.
• Manage projects that enhance processes and systems in partnership with IT, internal stakeholders, and external customers.
• Maintain effective internal controls to ensure the accuracy and completeness of financial transactions and reporting.
• Ensure compliance with applicable laws, regulations, policies, and operational standards.
• Manage departmental operating expenses, including salary and non-salary costs, within approved budgets.
• Oversee collection activities, enforce collection policies, and manage delinquent accounts in accordance with legal and regulatory guidelines.
• Lead, develop, and mentor supervisors and staff responsible for premium billing and collection functions.
• Build and maintain strong relationships with brokers, sales teams, customers, and other key stakeholders through effective communication and timely issue resolution.
• Strengthen internal controls to prevent financial errors, revenue leakage, and material misstatements.
• Represent the billing department in corporate projects and strategic initiatives, ensuring business requirements are effectively communicated and addressed.
• Collaborate with internal and external stakeholders to resolve billing, payment, and customer service inquiries.
• Ensure accurate monthly revenue reporting by reviewing, reconciling, and communicating premium collection activities to Finance.
• Maintain compliance with all required training, reporting, accreditation, and regulatory requirements.
• Develop and maintain strong cross-functional business partnerships while representing the premium billing department across the organization.
• Partner with external vendors to monitor performance, review service level agreements (SLAs), evaluate deliverables, and coordinate staffing requirements to support enrollment and billing operations.

WHAT YOU BRING

Education/Experience:

• High School Diploma or GED required.
• Bachelor’s degree in Finance, Economics, Accounting, or a related field preferred; equivalent combination of education and relevant experience may be considered.
• Minimum of five (5) years of managerial experience required.
• Prior service operations experience preferred.
• Minimum of 5 years of billing and enrollment operations experience.
• Experience managing in a fast paced, high volume, transaction-driven environment necessary.
• Successful track record managing inventory as well as other service operations metrics and reports, with process improvement experience preferred.

Knowledge:

• Strong knowledge of service operations, including customer service call centers, claims administration, membership, enrollment, billing, and premium collection processes.
• Experience leveraging emerging technologies, including Artificial Intelligence (AI) and Machine Learning (ML), to enhance operational efficiency, automate workflows, and improve billing outcomes.
• Knowledge of industry trends, regulatory requirements, project management methodologies, and operational best practices.
• Working knowledge of healthcare and/or insurance operations, products, policies, and procedures preferred.
• Thorough understanding of billing, premium collection, accounts receivable, and delinquency management best practices.
• Knowledge of financial controls, reconciliation processes, revenue reporting, and audit compliance requirements.
• Familiarity with vendor management, service level agreements (SLAs), and performance monitoring practices.
• Understanding of process improvement methodologies such as Lean, Six Sigma, root cause analysis, and continuous improvement principles.

Skills & Abilities:

• Proven leadership ability with strong decision-making, strategic thinking, and problem-solving capabilities.
• Excellent communication skills, both verbal and written, with the ability to influence stakeholders at all organizational levels.
• Strong analytical and quantitative skills with the ability to interpret data, identify trends, and develop actionable solutions.
• Ability to manage multiple priorities simultaneously in a fast-paced, high-volume environment.
• Skilled in relationship management, collaboration, negotiation, and conflict resolution.
• Strong project management skills with experience leading cross-functional initiatives and driving organizational change.
• Ability to coach, develop, and motivate teams to achieve performance, quality, and customer service objectives.
• Results-oriented mindset with a focus on accountability, continuous improvement, and operational excellence.
• Demonstrated ability to evaluate processes, identify efficiencies, and implement effective business solutions.
• Strong organizational skills with exceptional attention to detail and accuracy.
• Proficiency in Microsoft Office applications and business reporting tools.

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.