Overview

Description: The Supervisor of Complaint and Appeals will establish and Maintain in collaboration with all segments and business units, consistent policies and procedures defining the administration and resolution of complaints grievances and appeals from Aetna members and providers.
61041
Fundamental Components: Manages team’s productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns.
Serves as a content model expert and mentor to team regarding Aetna’s policies and procedures, regulatory and accreditation requirements.
Manages to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action.
Select staff using clearly defined requirements in terms of education, experience, technical and performance skills.
Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.
Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals.
Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turn-around time for Appeals and Complaints handling.
Ensures all Complaints and Appeals units are utilizing the National tracking tool to ensure reporting consistency and trend analysis.
Holds individuals/team accountable for results; recognize/reward as appropriate.
Lead change efforts while managing transitions within a team.
Identifies trends involving non-clinical issues and reports on and recommends solutions.
Additional duties as assigned, (e.g., Supervisors with less than 15 direct reports will also handle resolution work the % of the time they are not managing their staff). Background Experience: 1+ years Healthcare Experience; Required
1+ years Leadership Experience; Required
1+ years Managed Care Experience; Preferred
1+ years Complaint and Appeals Experience; Strongly Preferred
Bachelor’s degree or equivalent experience; Required

Additional Skills Preferred:
Experience documenting workflows and reengineering efforts
Excellent verbal and written communication skills
Solid project management skills
Excellent customer service skills
Experience with claim/call center environment
Additional Job Information: Maintains joint ownership throughout all phases of business system or technology delivery and beyond.
Ability to work across Aetna functions, segments and markets to accomplish business goals.
Ability to multi-task to accomplish workload efficiently.
Ability to assess return on value of proposed solutions and select option of greatest value.
Ability to revise priorities as appropriate to respond to change.
Ability to identify options that add value to constituents.
Excellent verbal and written communication skills. Required Skills: Leadership – Driving a Culture of Compliance, Service – Demonstrating Service Discipline, Service – Handling Service Challenges Desired Skills: General Business – Communicating for Impact, Leadership – Creating Accountability, Service – Case Administration Potential Telework Position: No Percent of Travel Required: 0 – 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate’s data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately. Qualifications: 1+ years Healthcare Experience; Required
1+ years Leadership Experience; Required
1+ years Managed Care Experience; Preferred
1+ years Complaint and Appeals Experience; Strongly Preferred
Bachelor’s degree or equivalent experience; Required

Additional Skills Preferred:
Experience documenting workflows and reengineering efforts
Excellent verbal and written communication skills
Solid project management skills
Excellent customer service skills
Experience with claim/call center environment
Employment Type: Maintains joint ownership throughout all phases of business system or technology delivery and beyond.
Ability to work across Aetna functions, segments and markets to accomplish business goals.
Ability to multi-task to accomplish workload efficiently.
Ability to assess return on value of proposed solutions and select option of greatest value.
Ability to revise priorities as appropriate to respond to change.
Ability to identify options that add value to constituents.
Excellent verbal and written communication skills.


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