Mgr, Exec DOBI Compl & Appls

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.

Responsible for the oversight of team dedicated to researching and responding to escalated complaints received from regulatory offices, e.g. Department of Banking and Insurance, Offices of the Attorney General, Legislative offices as well as those that are received by Horizon executives and the office of Public Affairs. Manager is responsible for ensuring mandated and internal goals for timeliness, quality and production are achieved.

• Direct staff to ensure overall member satisfaction while handling sensitive and escalated complaint issues within mandated resolution time frames.
• Develop and monitor goals for staff and provide ongoing feedback and coaching both internally and outside of the department, where appropriate.
• Develop/Update enterprise wide training material relative to Complaint/Appeal handling.
• Prepare and Monitor Enterprise Corrective Action Plan for Complaint/Appeal timeliness.
• Identify opportunities and best practices and implement process improvements (i.e., root cause analysis, technological assessments, etc.) to optimize performance and administrative cost.
• These improvements can be internal or may involve other departments within the organization.
• Responsible for timely adherence with compliance, training and reporting requirements as determined by internal and external regulatory/accreditation agencies and policies.
• Develop, administer and monitor Service Level Agreements (SLAs) with appropriate business partners to ensure timely and accurate responses to escalated complaints.
• Review and maintain Enterprise Administrative policies and Charters that govern Inquiries, Complaints and Appeals.
• Develop and/or maintain business partnerships and represent the department and the enterprise to Regulatory agencies.
• Perform other related tasks as assigned or required.

Experience/

Education:

HS Diploma or GED required. Bachelors Degree preferred. Minimum of five (5) years of managerial experience required. Experience managing in a fast paced, high volume, transaction-driven environment necessary. Successful track record managing inventory as well as other service operations metrics and reports, with process improvement experience preferred.

• Strong leadership, decision-making, strategic problem solving, negotiations, analytical, excellent verbal & written, and interpersonal skills.
• Strong and effective communication skills, both verbal and written.
• Strong analytical skills; uses to validate plans and approaches.
• Ability to understand and interpret consumer and group health plan contracts.
• A commitment to excellence and to making a difference; results driven, improvement focused, and action oriented self-starter who can handle various responsibilities simultaneously and proactively and continually look for a better way of doing things.

Some travel may be required.

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…