Complaint Resolution Analyst

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Conducts research, investigations, and coordinates resolutions for member and/or provider complaints.

• Leverages the IMAC database to extract information regarding complaints and maintain a tracking log.

• Ensures that resolutions for complaints adhere to State timing requirements for compliance.

• Collects data to create monthly and quarterly statistical reports.

• Engages in extensive follow-up with internal departments.

• Drafts complaint resolution letters addressed to physicians and members.

• Reviews the complaint database report on a weekly basis and follows up on unresolved issues.

• Completes and/or assists with monthly reporting obligations.

• Performs additional duties as assigned by management.

⛳️ Requirements

• A High School Diploma or GED is required.

• A minimum of 2 years of customer service or healthcare experience is necessary.

• Familiarity with healthcare delivery systems is required.

• Proficiency in PC usage and related software is required.

• Knowledge of State and Federal regulations is preferred.

• Strong verbal and written communication skills are essential.

• Strong analytical and logical thinking abilities are required.

• Good grammar, diction, and articulation are necessary.

• Proficient computer skills are required.

• Conflict resolution skills are necessary.

• A customer-focused approach with excellent listening skills is required.

• A commitment to quality is essential.

🏝️ Benefits

• Comprehensive health benefits including Medical, Dental, and Vision.

• Retirement plans available.

• Generous Paid Time Off (PTO).

• Incentive plans offered.

• Wellness programs available.

• Paid Volunteer Time Off.

• Tuition reimbursement offered.