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.

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.

Education/Experience:

High School Diploma/GED required.

Requires 2 years customer service or health care experience.

Knowledge:

Requires knowledge of health care delivery systems.

Requires knowledge of PC's and related software.

Prefers knowledge of State and Federal regulations

Skills and Abilities:

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

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, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

Comprehensive health benefits (Medical/Dental/Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

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.