Aetna Supervisor, Complaint & Appeal in Charleston, West Virginia

Req ID: 46110BR


Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner complaints/appeals. Responsible for organization and development of high performing teams to ensure timely, customer focused response to appeals. Facilitates effective interfaces among team members, as well as, other business units. Responsible for day-to-day implementation of Aetna's complaints and appeals policies and procedures. Identifies trends involving non-clinical (CRT/PRT) or clinical (MRT) issues and reports on and recommends solutions. Accountable for meeting the financial, operational, and quality objectives of the unit.

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 Manages a team of non-clinical personnel Serves as a content model expert and mentor to team in regards to Aetna's policies and procedures, regulatory and accreditation requirements Manages to performance measures and standards for quality service and cost effectiveness and coaches 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 & clinical issues and reports on and recommends solutions Additional duties as assigned


Project management experience Experience documenting workflows and reengineering efforts Ability to communicate clearly with auditors Organization skills


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Microsoft Visio/ 1-3 Years/ End User Microsoft Word/ 1-3 Years/ End User Microsoft PowerPoint/ 1-3 Years /End User


Benefits Management/ Interacting with Medical Professionals/ ADVANCED Service/ Handling Service Challenges/ ADVANCED General Business/ Communicating for Impact/ ADVANCED


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.

Job Function: Risk Management