Manager, Escalated Complaints & Appeals

Horizon Blue Cross Blue Shield of New Jersey; The Ironbound (NJ); Sur place; USD 110 000 - 150 000; Plein temps

Avantages offerts par ce poste

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Résumé du poste

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Manager to oversee a team that researches and responds to escalated complaints from regulators and executives, ensuring timeliness, quality, and production standards are met.

You will coach staff, develop training, monitor corrective action plans, and partner with regulatory bodies to maintain compliance while identifying process improvements to reduce cost and improve member experience.

Qualifications

• Minimum of five years of managerial experience.
• Experience in a fast-paced, high-volume environment.
• Strong leadership and communication skills.
• Knowledge of healthcare policies and NCQA knowledge a plus.

Responsabilités

• Direct staff to ensure member satisfaction and handle escalated complaint issues within mandated resolution times.
• Develop/update enterprise training material for Complaint/Appeal handling.
• Prepare and monitor enterprise Corrective Action Plans for timeliness.
• Identify opportunities for process improvements and implement best practices.
• Ensure adherence with compliance, training and reporting requirements.
• Develop and monitor SLAs with business partners; maintain policies governing Inquiries, Complaints and Appeals.

Connaissances

Leadership

Communication

Analytical skills

Strategic problem solving

Interpersonal skills

Formation

HS Diploma or GED required

Bachelor's Degree preferred

Description du poste

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Manager to oversee a team that researches and responds to escalated complaints from regulators and executives, ensuring timeliness, quality, and production standards are met.

You will coach staff, develop training, monitor corrective action plans, and partner with regulatory bodies to maintain compliance while identifying process improvements to reduce cost and improve member experience.