The Regulatory Complaint Analyst is responsible for responding to complaints initiated by regulatory agencies and oversees the complaint response process to facilitate timely resolutions and responses. Regulatory reporting required.
- Records all provider and member complaints and inquiries initiated by local, State and Federal regulatory agencies, as well as governmental contracted entities into company tracking system.
- Identifies the root causes of complaints and works with the applicable operational departments to implement an appropriate resolution – departments include, but are not limited to: Finance, Enrollment, Claims, Provider Relations & Contracting, Member Services, Medical Management and Product Management.
- Timely resolves assigned complaints for all lines of business (Medicaid, Child Health Plus, Essential Plan, Commercial, Managed Long Term Care and Medicare)
- Communicates these resolutions to the requesting agency via telephone or written correspondence.
- Assists the department in maintaining, tracking and following up on all regulatory directives received from governmental agencies.
- Extracts and analyzes complaints data to identify complaint trends and patterns.
- Assists in compilation of regulatory reports for submission to the State and/or local agencies, as needed.
- Assists with additional duties as assigned.
- MUST have an Associate's Degree from an accredited institution
- MUST have current/prior experience working in a regulated environment/managed healthcare environment
- MUST be proficient in using MS Office products - specifically using Excel to create pivot tables, vLookups and formulas
- Excellent oral and written skills
- Bachelor's Degree
- Prior experience with Medicare and Medicaid requirements
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement