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.

• Research, investigate and coordinate resolution to member and/or provider complaints.
• Utilize IMAC database to extract complaint information and tracking log.
• Ensure complaint resolutions meet State timing requirements to ensure compliance.
• Gather data to compile monthly and quarterly statistical reports.
• Conduct extensive follow‑up with internal areas.
• Write complaint resolution letters to physicians and members.
• Review the complaint database report weekly and follow‑up on outstanding issues.
• Complete and/or assist with monthly reporting requirements.
• Perform any other duties as assigned by management.

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

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

• Knowledge of health care delivery systems.
• Knowledge of PC's and related software.
• Knowledge of State and Federal regulations preferred.

• Strong verbal and written communication skills.
• Strong analytical and logical thinking.
• Good grammar, diction, and articulation.
• Good computer skills.
• Conflict resolution skills.
• Customer focus with excellent listening skills.
• Focus on quality.

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.

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

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.