Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
About the Role
This position is responsible for the research, investigation and follow-up to resolution of member and/or provider complaints for Horizon NJ Health and ensures timeliness guidelines and accuracy standards are met.What You'll Do
Responsibilities:Researches, investigates and coordinates resolution to member and/or provider complaints.
Utilizes IMAC database to extract complaint information and tracking log.
Ensures complaint resolutions meet State timing requirements to ensure compliance.
Gathers data to compile monthly and quarterly statistical reports.
Conducts extensive follow-up with internal areas.
Writes complaint resolution letters to physicians and members.
Reviews the complaint database report weekly and follow-up on outstanding issues.
Completes and/or assist with monthly reporting requirements.
Performs any other duties as assigned by management.
What You Bring
Education/Experience:High School Diploma/GED required.
Requires 2 years customer service or health care experience.
Knowledge:
Requires knowledge of health care delivery systems.
Requires knowledge of PC's and related software.
Prefers knowledge of State and Federal regulations
Skills and Abilities:
Requires strong verbal and written communications skills
Requires strong analytical and logical thinking.
Requires use of good grammar, diction and articulation.
Requires good computer skills.
Requires conflict resolution skills.
Requires customer focus with excellent listening skills.
Requires focus on quality.
Why Horizon?
At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!
Salary Range:
$50,100 - $67,095This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Disclaimer:
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Skills Required
- High School Diploma or GED
- 2 years customer service or health care experience
- Knowledge of health care delivery systems
- Knowledge of PCs and related software
- Strong verbal and written communication skills
- Strong analytical and logical thinking
- Good grammar, diction, and articulation
- Good computer skills
- Conflict resolution skills
- Customer focus with excellent listening skills
- Focus on quality
- Knowledge of State and Federal regulations
Horizon Blue Cross Blue Shield of New Jersey Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Horizon Blue Cross Blue Shield of New Jersey and has not been reviewed or approved by Horizon Blue Cross Blue Shield of New Jersey.
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Leave & Time Off Breadth — PTO is characterized as generous, with ample days off and holidays enhancing the overall package. This breadth of time away supports a favorable view of total rewards.
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Flexible Benefits — Remote and hybrid options are available in multiple functions and are cited as a meaningful perk. Flexibility in where work is performed contributes to overall satisfaction with rewards.
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Retirement Support — The 401(k) match is considered decent to good. Retirement offerings are viewed as a solid component of the total package.
Horizon Blue Cross Blue Shield of New Jersey Insights
What We Do
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company. Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ. Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
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