Aetna Supervisor Complaint & Appeal in Moon township, Pennsylvania

Req ID: 44951BR

POSITION SUMMARY

Supervisor responsible for the management of a Medicare Complaints Team of approximately 15 analysts. Supports the administration and resolution of complaints (CTMs) ensuring that team is taking appropriate action to research, investigate, and resolve member issues timely. Identifies trends, raises awareness and recommends solutions. Monitors, coaches, and develops analysts. Collaborates and partners with other Grievance Supervisors. Accountable for member satisfaction and acting as an advocate for our members.

Fundamental Components:

Medicare Complaint Supervisor is responsible for day-to-day management of their team to ensure effective, timely and customer-focused resolution of Medicare member grievances. Facilitate communication amongst team members. Collaborate across organizational boundaries to resolve service issues, improve service levels and maximize member satisfaction. Identify complaint trends and issues; provide reports and recommend solutions as appropriate.

BACKGROUND/EXPERIENCE required:

1-3 years Medicare experience in research and analysis of complaint processing. Experience working with Medicare benefits and or customer service experience.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Customer Service/Customer Service - Member Services - HMO products/1-3 Years

Functional - Products-Medical/Individual Medicare Advantage Plan/1-3 Years

Functional - Products-Medical/Individual Medicare Prescription Drug Plan/1-3 Years

Functional - Leadership/Lead a complex or multifunctional organization/1-3 Years

Functional - Claims/Claim processing - Medical - Medicare/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Medicare Intake Database/1-3 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools///

REQUIRED SKILLS

Leadership/Creating Accountability/ADVANCED

General Business/Communicating for Impact/ADVANCED

Service/Handling Service Challenges/ADVANCED

DESIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

Leadership/Engaging and Developing People/FOUNDATION

General Business/Maximizing Work Practices/ADVANCED

ADDITIONAL JOB INFORMATION

Must have the ability to exemplify Aetna values in daily work, promote collaborative relationships with others and foster a sense of teamwork with internal/external constituents which includes regular interaction with medical providers, peers, Medicare members, regulatory agencies and the management team. Must be able to multi-task in a fast paced environment. Must remain flexible with the ability to adapt to change in the work environment and perform assigned tasks with accuracy. Must be able to adjust to regulatory, departmental and workflow changes. Must have the skill set to communicate and draft correspondence to internal/external constituents in a clear, concise and professional manner. Must have the ability to adhere to strict regulatory timeframes and meet established metrics. Must maintain focus on producing high quality work. Organization skills are essential and a tool used to maintain compliance with individual inventory assignment. Medicare knowledge required. MedHOK knowledge is desired.

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