NJM Insurance Group

Call Center Representative

• Provide excellent service to customers through the resolution of basic customer inquiries received by phone or through written correspondence.
• Receive customer inquiries via phone, fax, mail, e-mail, etc.
• If necessary, probe for additional helpful information (i.e. member ID, claim number, name, etc.) to effectively handle inquiry.
• Review computer systems and/or other reference materials to complete verification process.
• Initiate investigation process based on the nature of the inquiry (claim, member information, benefits, enrollment, appeals, etc.).
• Utilize available resources to quickly and efficiently resolve or redirect inquiries in accordance with prescribed departmental process.
• Accurately document customer inquiries and actions taken in accordance with departmental quality guidelines to ensure appropriate follow up.
• Follow up on unresolved issues in a timely manner, escalating call trends to management.
• Deliver an excellent customer service experience while meeting quality and production standards.
• Perform other relevant tasks as assigned by management.

Call Center Associate

Human Resources

• Serve as a senior-level advisor to executives and business leaders, providing guidance on workforce planning, organizational strategy, team effectiveness, and leadership capability.
• Deeply understand the business’s goals, operating model, and challenges to develop integrated people solutions that accelerate performance.
• Use analytics, trend data, and insight-driven decision-making to proactively identify opportunities and mitigate risks.
• Lead organizational design efforts, including structure assessments, capability mapping, role clarity, and change impact analysis.
• Partner with business leaders to forecast talent needs and ensure the workforce is aligned to short- and long-term business plans.
• Drive the talent lifecycle, including succession planning, performance management, leadership pipeline development, and high-potential identification.
• Coach executives and people leaders to enhance leadership competencies, strengthen decision-making, and elevate team performance.
• Provide advanced guidance on complex employee relations matters, partnering with Legal and Employee Relations as needed.

HR Generalist II

Network Engineer

• Serves as the key external-facing member of the behavioral health network management team for the behavioral health professional network in their designated geographic area
• Analyzes membership and geographical access by BH Specialty to determine specific goals and action plans for targeted recruitment of new practitioners
• Performs activities that develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the behavioral health provider network
• Provides input to behavioral health special payment arrangement contract renewals
• Informs and educates behavioral health practitioners on Horizon's products and services
• Engages in proactive outreaches to high volume behavioral health groups in their designated territories
• Analyzes provider related information and data to recommend actions and solutions to strengthen the provider’s relationship with Horizon
• Initiates communication with other members of BH network management team to effectively troubleshoot complex claim situations
• Alerts leadership to potential issues risks, and opportunities identified through behavioral health network interactions
• Plans, organizes, and presents seminars to various BH network practitioners and groups
• Maintains a thorough knowledge of healthcare industry trends and developments
• Identifies, researches, recommends and implements potential saving opportunities for the delivery of cost-effective and quality care

Behavioral Health Network Specialist

Business Analyst

• Investigate service related issues to identify root cause of issues
• Develop forecasting tools using current technology/systems (Access, Excel, Monarch, etc.)
• Translate business requirements and assist IT with the development of technical specifications
• Develop solutions based on data analysis to increase business efficiency
• Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
• Prepare materials for internal and external audit activities; review audit findings/reports for accuracy and completeness
• Coach/mentor less experienced staff and assist in on-boarding
• Responsible for using multiple data sets to create reports, conduct analysis and research

Business Analyst III

Designer

• The IT intern will be asked to participate in projects from inception to production deployment
• Assist the Application Development team in various activities, including adoption of AppOps and DevSecOps, implementation of continuous delivery pipelines, automation of job functions, and creation of information management dashboards
• Participate in team activities, including status meetings, design sessions, product demos, and code reviews
• Engage in all aspects of the software delivery lifecycle
• Provide and share weekly status updates

IT Intern – Application Development, Website Design

General Counsel

• Provides advice to management on legal issues relating to insurance regulatory law for the Medicare Advantage and Medicare Supplement lines of business.
• Supports the Sales and Broker Operations teams regarding Medicare regulations specific to the Government Programs lines of business.
• Handles legal inquiries from within the company.
• Responds with legal opinion as appropriate.
• Serves on various internal committees as both participant and counsel.

Associate General Counsel

Analyst

• Manage the resolution of out of network billing disputes
• Handle negotiation cases within regulatory timeframes
• Timely and accurate creation and closure of Interactions and Intents via SharePoint
• Completion of eligibility verification upon assignment of mandated cases
• Interacts with relevant parties for negotiation resolutions
• Research and review negotiation attempts for accuracy
• Update high dollar negotiation files
• Prepare written responses including negotiation outcomes
• Handle responses for Escalated complaints from CMS/DOBI/DOL
• Conduct detailed root cause analysis

OON Mandate Negotiation Analyst

• Advise/counsel across assigned functions related to the organization’s legal rights and obligations
• Provide legal counsel in business-related areas of expertise and identify/assess risk
• Research, analyze, and interpret proposed and existing laws, statutes, and regulations
• Structure, draft, negotiate and/or approve legal contracts, letters of agreement, policies and other documents related to operational matters
• May be accountable for liaising with external legal counsel on complex legal issues
• Liaison with regulators in certain jurisdictions, as necessary
• Perform other miscellaneous responsibilities and duties as assigned or directed
• Responsible for assisting on transactional matters, including commercial contracts and negotiations pertaining to the Company’s supplier, services, and real estate

Corporate Counsel

Business Operations

• Support the planning and execution of business projects
• Provide support to Process Engineers and Business partners towards pre-initiative process/benefit analyses
• Aid creation of high-level and detailed business cases
• Utilize appropriate Lean Six Sigma tools to help ensure project deliverables are met with high quality and in a timely manner
• Participate in presentations of project updates and outcomes to various levels of management
• Demonstrate strong relationship building and collaboration skills with team members and business partners.

Business Process Improvement Intern

Project Manager

• Assist project managers in planning, organizing, and tracking project activities and deliverables.
• Support project execution by coordinating meetings, documenting action items, and maintaining project schedules.
• Help prepare project status updates, dashboards, and reporting materials for leadership.
• Lead the facilitation and execution of Detailed Business Case (DBC) creation, including coordinating stakeholders, gathering required inputs, organizing documentation, and ensuring timely completion of business case components.
• Coordinate deployment or implementation activities by logging, tracking, and communicating tasks.
• Review and document existing project workflows or processes and identify opportunities for improvement.
• Assist in troubleshooting and monitoring non-production project-related issues and escalating as needed.
• Collaborate with team members to ensure timely communication and smooth project operations.

Project Management Intern

Procurement

• Undertakes an internship designed to provide on-the-job training and experience
• Engage in various work assignments, projects, and activities of varying complexity, structured to enable the intern to gain the necessary knowledge, skills, and abilities needed to perform at a professional level
• Receive training and mentorship in planning and carrying out activities and assignments
• Undertake and/or participate in research, projects, and programs designed to develop professional skills and expertise appropriate to the needs of the organization
• Perform miscellaneous job-related duties as assigned
• Day-to-day tasks may include gathering, organizing, and visualizing key vendor performance data
• Involves manual research, data validation, and assisting in the development of performance scorecards dashboards used for executive reporting and operational insights to support the Enterprise Vendor Management team

Strategic Sourcing Intern

• Undertakes an internship designed to provide on-the-job training and experience
• Engage in various work assignments, projects, and activities of varying complexity, structured to enable the intern to gain the necessary knowledge, skills and abilities needed to perform at a professional level.
• Undertake and/or participates in projects and programs designed to develop professional skills and expertise appropriate to the needs of the organization.
• Implement analytic tools and techniques to identify medical cost drivers and ways to improve medical cost performance
• Translate advanced excel reporting and data into comprehensive presentations for leadership
• Assist with process and performance improvement efforts by supporting data collection, documentation, and tracking activities.
• Help monitor project status by preparing summaries and updating dashboards under guidance from multidisciplinary team leads.
• Support workstream leaders by organizing materials, scheduling meetings, and following up on action items.
• Conduct basic research and analysis to provide input for recommendations and presentations.
• Assist in identifying improvement opportunities by gathering data and reviewing industry trends.
• Learn and apply key financial and operational concepts through hands-on tasks and shadowing team members.
• Help prioritize tasks by maintaining project trackers and ensuring timely updates.
• Contribute to continuous improvement efforts by documenting processes and suggesting enhancements based on observations.
• Manage meeting logistics including scheduling, preparing agendas, and compiling deliverables such as reports.
• Perform miscellaneous job-related duties as assigned.

Medical Cost Project Management Intern

Security Engineer

• Assist in the administration of security technology stack
• Provide general support to the security team on projects and daily team tasks
• Assist in monitoring systems activity
• Review security documentation, policies, and procedures
• Participate in security awareness initiatives and training projects
• Learning how to assess and manage human risk related to cybersecurity
• Participate in security audit and assessment meetings and evidence collections process

Cyber Security Intern – Security Governance

• Participate in all internship activities and events scheduled during normal business hours
• Assist with research, planning, and implementation of strategic corporate initiatives related to HRBP efforts
• Support the development and implementation of new resources and trainings with members of the team
• Contribute innovative ideas and share best practices relevant to HR
• Assist in performance management, talent development and employee relations processes

Human Resources Intern

Operations

• Supervises, analyzes and coordinates the work of the business team to ensure that quality and productivity goals are met.
• Provides help, guidance, training, technical training and instructions to staff so that team members can improve their performance and broaden their skill sets.
• Ensures an atmosphere within the business team which fosters open communication, teamwork, participation, ownership, and empowerment to make decisions.
• Evaluates the performance of the business team as a whole and of the individual members of the team.
• Ensures that the customer is satisfied with the level of service provided.
• Acts as technical expert and reference point for difficult and complex matters.
• Facilitates the creation of service and processing innovations within the team. Shares innovations with other teams and market divisions.
• Monitors and reports on key performance indicators to team members and to upper management.
• Assists in preparing and monitoring the budget to ensure administrative cost objectives are met. Identifies and implements cost saving/revenue generating opportunities.