Complaint Resolution Analyst

Our growing company is looking for a Complaint Resolution Analyst to help us continuously improve our business operations. The Complaint Resolution Analyst is responsible for reviewing, analyzing, and defining RCCA’s based upon member complaints.  This includes leadership communications, creating CAPA’s, and using leadership skills to guide a complaint handling team.  The team is responsible for answering and resolving member complaints for those covered with Uprise Health and the various client plans. You will perform in-depth QA on the data and process that supports the member experience with the goal of delivering 0 member defects from the member processes.

Annual Salary $65,000-$80,000 per year (dependent on experience)  

• Conduct periodic audits and reviews of various Uprise Health department activities, for example but not limited to paid claims, provider files and fee schedules, member services activities, and authorization processes to ascertain accuracy, and timeliness of processing and compliance with regulatory requirements
• Conduct periodic audit and review to ensure compliance with established policies, plans, procedures, and performance standards
• Analyze and monitor data through various systems
• Monitor and report on defect resolution to management
• Provide actionable recommendations for improving data quality and process integrity
• Work with stakeholders to understand, reproduce, and address defects identified by members or internal parties
• Participate in training and/or mentoring programs
• Assist in ensuring compliance with all regulatory agencies in accordance with state, federal, and contractual requirements
• Assists in monitoring existing regulations to ensure Uprise Health operational compliance via audits and investigations within Uprise Health departments
• Assists and communicates with the appropriate management in the process of timely response of any Corrective Action Plan (“CAP”)
• Coordinate, prepare, and monitor assigned special projects and reports as required.
• Assist with the coordination and submission of filings, regulatory forms, surveys, reports and documents as required or requested by management.
• Provides Stakeholders with information to facilitate understanding and compliance with regulatory requirements. This includes researching regulations, informing departments of regulations and developing policies and procedures to comply
• Assist in miscellaneous duties and ad hoc projects

• Bachelor's degree in Business, Finance, Education, Accounting, Business/Administration, Management, Computer Science, Economics
• Basic to Intermediate SQL skills working with large datasets
• Minimum two years of experience in a QA/complaint analysis position
• Hands on experience executing projects, defining root cause, and planning corrective actions
• Experience in QA/complaint analysis processes, methodologies, tools, and industry best practices
• Excellent process, project, and problem-solving skills required.
• Advanced MS Office applications (Excel, PowerPoint, Outlook, Access) and SQL preferred
• Must be highly organized and detail oriented and able to manage multiple priorities simultaneously and meet established deadlines
• Ability to learn new computer systems rapidly and then accurately and completely document all activities
• Must have Leadership skills like relationship management, collaboration, facilitation, and influencing
• Must have good communication, interpersonal and project Management skills and be able to interact with senior leadership / business partners / customers
• Knowledge of Sales Force and Quick Cap is preferred
• Must be a self-starter and able to perform with minimal supervision while working in a diverse team
• Knowledge of managed care industry operations, practices, and standards preferred
• Knowledge of compliance program practices and elements preferred

Working Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.