Medical Policy Analyst – Part-Time, 32 hrs weekly

Horizon Connect @ Wall BCBSNJ

Part-time Medical Policy Analyst reviewing medical necessity and appealed claims for Horizon Blue Cross Blue Shield of New Jersey. Ensuring policy, benefit, coding, and regulatory compliance through clinical record and claims analysis.

Posted 8/14/2026part-timeRemote • Connecticut, New Jersey, New York, Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $70,500 - $94,395 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical necessity reviews, compliance with medical policies, and effective communication with stakeholders. Proven ability to manage multiple priorities while adhering to ethical business practices and delivering timely, accurate work products.

Highest-signal resume keywords

Clinical Nursing ExperienceMedical Policy ComplianceEffective Communication SkillsTime Management SkillsProblem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Soft Skills

Team CollaborationCustomer Service FocusProfessional EthicsAdaptability to ChangeSound Judgment

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Medical Necessity ReviewClaims ProcessingProvider CodingWorkflow ChangesRegulatory Compliance

About the role

Key responsibilities & impact

Perform reviews of post-service medical necessity and appealed claims for compliance with medical policy, plan benefits, and provider coding
Prepare cases for Medical Director and/or outside consultant review and response where appropriate
Provide timely and accurate responses to inquiries and collaborate with claim policy teams regarding claims pending medical review and appeal inquiries
Communicate opportunities for development or revision of Horizon Medical Policies based on case review outcomes
Manage assigned inventory, document production, and follow assignments through completion
Stay abreast of mandates, policy, and workflow changes impacting the review process and outcomes
Apply knowledge of laws, regulations, and organizational policies to job accountabilities

Requirements

What you’ll need

High School Diploma/GED required
Minimum of 3 years’ clinical nursing experience
Effective verbal and written communication skills
Ability to work well within a team
Professional and ethical business practices
Adherence to company standards
Commitment to personal and professional development
Proven time management skills
Ability to manage multiple priorities or tasks
Ability to deliver timely and accurate work products with a customer service focus
Ability to respond with a sense of urgency as required
Ability to work in a production-focused environment
Sound judgment and strong problem-solving skills
Ability to ask probing questions and obtain thorough and relevant information
Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Mission-driven organization that values expertise, collaboration, and growth
Reasonable accommodation requests supported during recruiting and hiring