[Remote] Complaint Res Analyst
Auto ImportNote: 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