Complaint Resolution Analyst

Job Summary

Responsible for researching and resolving member and provider complaints, the full-time Complaint Resolution Analyst will ensure compliance with state timing requirements and accuracy standards while working remotely.

Key responsibilities

• Researches, investigates, and coordinates the resolution of member and provider complaints
• Utilizes the IMAC database to track complaint information and compiles statistical reports
• Writes complaint resolution letters and conducts follow-ups with internal areas to ensure timely resolutions

Required qualifications

• High School Diploma or GED required
• Minimum of 2 years of customer service or healthcare experience
• Knowledge of healthcare delivery systems and relevant state and federal regulations preferred
• Proficiency in PC and related software
• Strong analytical skills and ability to handle conflict resolution effectively