Complaint Res Analyst

About The Role

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.

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.

Education/Experience

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

Skills And Abilities

• Strong verbal and written communications skills.
• Strong analytical and logical thinking.
• Good computer skills.
• Conflict resolution skills.
• Customer focus with excellent listening skills.
• Focus on quality.

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!

Pay

Salary Range $50,100 - $67,095. 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.

Benefits

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

Disclaimer

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.