Complaints & Appeals Operations Manager (Escalations)

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive programs

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a senior manager to oversee an escalated complaints team. You will ensure timely resolution, staff development, and adherence to regulatory standards in a fast-paced health care environment.

You will lead training initiatives, monitor KPIs, and collaborate with partners to drive improvements in member experience while aligning with company goals and compliance obligations.

Qualifications

• Minimum of five (5) years of managerial experience.
• Experience in fast paced, high volume, transaction-driven environment is necessary.
• Experience with inventory and service operations metrics and process improvement is preferred.

Responsibilities

• Direct staff to ensure overall member satisfaction within mandated resolution timeframes; provide feedback and coaching.
• Develop/update enterprise-wide training material for Complaint/Appeal handling.
• Prepare and monitor Enterprise Corrective Action Plans for timeliness.
• Identify opportunities and implement process improvements to optimize performance and cost.
• Ensure compliance, training and reporting per regulatory requirements.

Skills

Leadership

Problem solving

Communication

Analytical

Negotiation

Education

Bachelor's degree

HS Diploma

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a senior manager to oversee an escalated complaints team. You will ensure timely resolution, staff development, and adherence to regulatory standards in a fast-paced health care environment.

You will lead training initiatives, monitor KPIs, and collaborate with partners to drive improvements in member experience while aligning with company goals and compliance obligations.