Complaint Res Analyst

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

21h

About The Position

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. 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.

Requirements

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.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Nice To Haves

Prefers knowledge of State and Federal regulations

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.