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. This position is responsible for resolving escalated member inquiries by phone or through written correspondence. The position works closely with Call Center Operations to help coordinate an excellent member service experience for members.Responsibilities:Receive escalated member inquiries via phone, fax, mail, e-mail, online, social media, etc. Probe for additional helpful information (i.e. member ID, claim number, name, etc.) in order to effectively handle inquiry.Review computer systems and/or other reference materials to complete verification process and ensure all privacy protocols are met.Initiate investigation process based on the nature of the inquiry (claim, member information, benefits, enrollment, appeals, authorization, etc.) and work with other areas within the organization to resolve the issue.Accurately document member inquiries and actions taken in accordance with departmental quality guidelines to ensure appropriate follow up.Follow up on unresolved issues within set timeframes.Identify trends and begin root cause analysis of systemic issues/problems. Escalate trend information to management on a timely basis.Perform outbound calls to ensure member satisfaction and review customer service tickets to review proper documentation and accuracy.Responsible for updates on Primary Care Physician (PCP) changes and facilitating fulfilment of requests to comply with 504 requirements.Conduct MLTSS member survey for feedback on case manager visits.Education/Experience:High School Diploma/GED required.Call center/customer service experience within the health insurance industry required.Skills and Abilities:Requires strong oral and written communication skills.Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)Excellent customer service skills including the ability to manage and diffuse irate calls.Ability to work in a high pressure, fast-paced environment.Requires good presentation skills.Requires Project Management SkillsRequires excellent interpersonal and organizational skills.Requires good Investigative and analytical skillsAbility to multitaskTime management skills.Flexibility and adaptabilityAbility to work effectively within a team environmentTravel: Minimal travel requiredHorizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareSalary Range:$43,900 - $58,800This 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 PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition ReimbursementDisclaimer: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.