Manager, Executive DOBI Compliance & Applications

Horizon Connect @ Wall BCBSNJ

. Oversee a team dedicated to researching and responding to escalated complaints from regulatory offices, executives, and Public Affairs .

Posted 10/27/2026full-timeUnited StatesMid-LevelSenior💰 $109,600 - $149,625 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing escalated complaints and service operations within regulatory frameworks, ensuring compliance and effective communication. Proven ability to lead teams, implement process improvements, and develop training materials to enhance operational efficiency.

Highest-signal resume keywords

Managerial ExperienceService Operations ManagementProcess ImprovementRegulatory Compliance KnowledgeStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Complaint HandlingProject ManagementData AnalysisService Level Agreement AdministrationInventory Management

Soft Skills

LeadershipDecision-MakingStrategic Problem SolvingNegotiationInterpersonal Skills

Industry Keywords

Health Care ReformNCQA RequirementsDOL RegulationsState and Federal MandatesInsurance Policy Operations

About the role

Key responsibilities & impact

Oversee a team dedicated to researching and responding to escalated complaints from regulatory offices, executives, and Public Affairs
Ensure mandated and internal goals for timeliness, quality, and production are achieved
Direct staff handling sensitive and escalated complaint issues within mandated resolution timeframes
Develop and monitor staff goals and provide ongoing feedback and coaching
Develop and update enterprise-wide complaint/appeal handling training material
Prepare and monitor enterprise corrective action plans for complaint/appeal timeliness
Identify best practices and implement process improvements, including root cause analysis and technology assessments
Ensure compliance, training, and reporting requirements are met
Develop, administer, and monitor Service Level Agreements with business partners
Review and maintain enterprise administrative policies and charters governing inquiries, complaints, and appeals
Develop business partnerships and represent the department and enterprise to regulatory agencies
Perform other related tasks as assigned or required

Requirements

What you’ll need

HS Diploma or GED required
Bachelors Degree preferred
Minimum of five (5) years of managerial experience required
Experience managing in a fast paced, high volume, transaction-driven environment necessary
Successful track record managing inventory as well as other service operations metrics and reports, with process improvement experience preferred
Proficient in service operations; managing inbound customer service call centers claims, call center, membership and billing processes
Knowledge of industry trends, legislation, and execution of project management
Knowledge of State and Federal Mandates, regulations, Health Care Reform
Knowledge of NCQA requirements and policies
Knowledge of healthcare or insurance policy and/or operations preferred
Requires knowledge of DOL regulations as they relate to member appeals
Strong leadership, decision-making, strategic problem solving, negotiations, analytical, excellent verbal & written, and interpersonal skills
Strong and effective communication skills, both verbal and written
Strong analytical skills; uses to validate plans and approaches
Ability to understand and interpret consumer and group health plan contracts
Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Some travel may be required

Benefits

Comp & perks

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