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Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health and has been a leader in health solutions for over 90 years. The Complaint Resolution Analyst is responsible for researching and resolving member and provider complaints while ensuring compliance with state requirements.
Responsibilities
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
Skills
High School Diploma/GED required
Requires 2 years customer service or health care experience
Requires knowledge of health care delivery systems
Requires knowledge of PC's and related software
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
Prefers knowledge of State and Federal regulations
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company Overview
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is
