[Remote] Complaint Res Analyst

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey is a health solutions leader in New Jersey, committed to improving health care quality and member experience. The Complaint Resolution Analyst position is responsible for researching, investigating, and resolving member and provider complaints, ensuring compliance with state guidelines and accuracy standards. 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 • Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com. Apply tot his job Apply To this Job