Senior Manager, Regulatory Complaints & Compliance Programs

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

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager to oversee the team that researches and responds to escalated complaints from regulators and executives. You will ensure timeliness, quality, and production goals are met while guiding staff through complex cases.

This role focuses on developing training, monitoring corrective actions, implementing process improvements, and maintaining compliance with state and federal mandates.

Qualifications

• HS Diploma or GED required; Bachelor's Degree preferred.
• Minimum of five years of managerial experience.
• Experience in a fast paced, high volume environment.

Responsibilities

• Direct staff to ensure overall member satisfaction while handling escalated complaint issues within mandated resolution timeframes.
• Develop/Update enterprise wide training material relative to Complaint/Appeal handling.
• Prepare and Monitor Enterprise Corrective Action Plan for Complaint/Appeal timeliness
• Identify opportunities and best practices and implement process improvements to optimize performance and cost.
• Ensure timely adherence with compliance, training and reporting requirements with regulatory agencies.
• Develop, administer and monitor SLAs with appropriate business partners.
• Review and maintain Enterprise Administrative policies and Charters that govern Inquiries, Complaints and Appeals.
• Develop and/or maintain business partnerships and represent the department to Regulatory agencies.
• Perform other related tasks as assigned or required.

Skills

Leadership

Decision-making

Strategic problem solving

Communication

Analytical skills

Interpersonal skills

Education

HS Diploma or GED

Bachelor's Degree preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager to oversee the team that researches and responds to escalated complaints from regulators and executives. You will ensure timeliness, quality, and production goals are met while guiding staff through complex cases.

This role focuses on developing training, monitoring corrective actions, implementing process improvements, and maintaining compliance with state and federal mandates.