[Hiring] Complaint Resolution Analyst @Horizon Blue Cross Blue Shield of New Jersey

Role Description

This position is responsible for the research, investigation and follow-up to resolution of member and/or provider complaints for Horizon NJ Health and ensures timeliness guidelines and accuracy standards are met.

What You'll Do

• Researches, investigates and coordinates resolution to member and/or provider complaints.
• Utilizes IMAC database to extract complaint information and tracking log.
• Ensures complaint resolutions meet State timing requirements to ensure compliance.
• Gathers data to compile monthly and quarterly statistical reports.
• Conducts extensive follow-up with internal areas.
• Writes complaint resolution letters to physicians and members.
• Reviews the complaint database report weekly and follow-up on outstanding issues.
• Completes and/or assist with monthly reporting requirements.
• Performs any other duties as assigned by management.

Qualifications

• High School Diploma/GED required.
• Requires 2 years customer service or health care experience.

Requirements

• Requires knowledge of health care delivery systems.
• Requires knowledge of PC's and related software.
• Prefers knowledge of State and Federal regulations.
• Requires strong verbal and written communications skills.
• Requires strong analytical and logical thinking.
• Requires use of good grammar, diction and articulation.
• Requires good computer skills.
• Requires conflict resolution skills.
• Requires customer focus with excellent listening skills.
• Requires focus on quality.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Salary Range

$50,100 - $67,095