Regulatory Complaints & Appeals Manager

100 Horizon Healthcare Services, Inc; Newark (NJ); In loco; USD 110.000 - 150.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Descrizione del lavoro

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced Manager to oversee a team handling escalated complaints from regulatory bodies and executives. You will ensure timely, high-quality responses and drive process improvements across the complaints/appeals workflow.

Lead staff performance, develop training materials, and maintain compliance with internal and external requirements while collaborating with other departments and regulatory agencies.

Competenze

• HS Diploma or GED required; Bachelor's degree preferred.
• Minimum of five (5) years of managerial experience in a fast-paced, high-volume environment.

Mansioni

• Direct staff to ensure overall member satisfaction while handling escalated complaints within mandated resolution timeframes.
• Develop and monitor goals for staff and provide ongoing feedback and coaching.
• Develop/update enterprise training material for Complaint/Appeal handling.
• Prepare and monitor Enterprise Corrective Action Plan for Complaint/Appeal timeliness.
• Identify opportunities and implement process improvements to optimize performance and costs.
• Maintain SLAs with business partners for timely and accurate escalated responses.
• Review and maintain Enterprise policies governing Inquiries, Complaints and Appeals.
• Represent department to Regulatory agencies and external partners.
• Perform other related tasks as assigned.

Conoscenze

Leadership

Decision-making

Strategic problem solving

Negotiations

Analytical

Verbal & written communication

Interpersonal skills

Formazione

HS Diploma or GED

Bachelor's Degree preferred

Descrizione del lavoro

Horizon Blue Cross Blue Shield of New Jersey seeks an experienced Manager to oversee a team handling escalated complaints from regulatory bodies and executives. You will ensure timely, high-quality responses and drive process improvements across the complaints/appeals workflow.

Lead staff performance, develop training materials, and maintain compliance with internal and external requirements while collaborating with other departments and regulatory agencies.