Complaint Resolution Analyst

NJM Insurance Group

Complaint Resolution Analyst for Horizon Blue Cross Blue Shield resolving member and provider complaints with adherence to compliance standards and timely reporting.

Posted 7/14/2026full-timeRemote • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $50,100 - $67,095 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in complaint resolution within health care delivery systems, ensuring compliance with State and Federal regulations while maintaining a strong focus on customer service and quality. Proficient in data analysis and reporting, with strong verbal and written communication skills.

Highest-signal resume keywords

Customer Service ExperienceHealth Care Delivery Systems KnowledgeConflict Resolution SkillsAnalytical ThinkingVerbal And Written Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisStatistical ReportingComplaint ResolutionDatabase ManagementPC Proficiency

Soft Skills

Customer FocusListening SkillsLogical ThinkingGood GrammarArticulation

Tools & Technologies

IMAC DatabaseMicrosoft Office

Industry Keywords

State RegulationsFederal RegulationsHealth Care Compliance

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

High School Diploma/GED required
Requires 2 years customer service or health care experience
Requires knowledge of health care delivery systems
Requires knowledge of PC's and related software
Prefers knowledge of State and Federal regulations
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.

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement