Job Description

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 Self Direction Personal Preference Program (PPP) Support Counselor Lead provides advanced program expertise while continuing to perform core PPP Support Counselor functions. This role mentors, trains, and precepts new and existing staff, serving as a subject matter expert across all PPP workflows, including initial and quarterly in person member visits. The Lead supports operational functions such as budgeting, scheduling, forecasting, capacity monitoring, and safety, and provides strategic guidance on cash management plans. Additionally, the role consults complex cases, supports quality assurance efforts, and promotes regulatory compliance, consistency, and continuous improvement across the program.

What You'll Do

• Perform PPP Support Counselor duties in accordance with established guidelines while supporting the preparation of new and existing counselors for independent work through training, mentoring, and hands-on guidance.

• Serve as a PPP subject matter expert, offering technical assistance, knowledge-sharing, and remediation support to peers as needed.

• Provide expertise on organizational and Fiscal Intermediary (FI) vendor medical management systems.

• Act as a regional triage resource for PPP-related complaints, grievances, and appeals, ensuring appropriate routing, documentation, and follow-up in alignment with policy.

• Travel within the state as needed to support training initiatives, staff development, and case coverage.

• Adhere to and support protocols related to PPP Support Counselor retraining and continuous quality improvement.

• Prepare and present mentee progress updates to leadership, highlighting outcomes, skill development, and opportunities for further improvement.

• Complete special projects and other duties as assigned by management to support program operations and quality outcomes.

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What You Bring

Education/Experience:

• High School Diploma/GED required.

• LPN or healthcare background preferred.

• Equivalent and relevant professional experience in budgeting or finance preferred.

• Minimum of 5 years’ experience in the health insurance industry or professional business-related field required.

• Must have a minimum of 3 years’ experience with financial counseling for the Personal Preference program.

• Experience with MS Office and other WFM solutions highly preferred.

Knowledge:

• Knowledge of Healthcare industry preferred.

• Team player, strong analytical and interpersonal skills.

• Proficient in MS Word, MS Excel and MS PowerPoint.

Skills and Abilities:

• Demonstrate strong analytical skills with emphasis on forecasting.

• Requires effective communication and presentation skills, as needed in a lead/trainer position.

• Requires the ability to work independently and resolve problems through interaction with multiply departments and personnel.

• Requires strong knowledge of the PPP Support Counselor role and ability to be highly organized with an emphasis on accuracy and timeliness.

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:

$79,100 - $105,945

​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.