Aetna Grievance Analyst in San Antonio, Texas

Req ID: 44449BR

This position is open to applicants from all Aetna locations.

POSITION SUMMARYSeeking organized and motivated individuals to join the Medicare Grievance team as a Grievance Analyst. Grievance Analyst will be responsible for investigating and resolving oral and written grievances received for all products. The grievance may contain multiple issues and may require coordination of responses from multiple business units. Must ensure timely, customer focused response to complaints, both oral and written. Identify trends and emerging issues and report and recommend solutions.

Fundamental Components:

  • Review of contract materials

  • Interpret Medicare Regulations and Guidance

  • Strong written and verbal communication skills

  • Draft letters to members in a clear and concise manner

  • Update internal system, documenting the activity of case file review with clarity and accuracy

  • Maintain accountability for resolving each case within established internal timeframes

  • Recognize trends and provide solutions

    BACKGROUND/EXPERIENCE:

  • Candidate should have claims; benefit knowledge to include the ability to navigate through Aetna systems

  • Must resolve each and every case in accord with the regulatory timeframes

    -Strong written and verbal communication skills required

  • 2-3 years Medicare experience is a plus

  • 2-3 years Customer Service experience is a plus

    EDUCATION

    The highest level of education desired 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/All Individual Medicare Plans/1-3 Years

    Functional - Products-Other/Pharmacy/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Aetna Applications/Complaints & Appeals Tracking System/1-3 Years/End User

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

    Technical - Aetna Applications/Medicare Evidence of Contract/1-3 Years/End User

    Technical - Aetna Applications/Medicare Annual Notice of Change/1-3 Years/End User

    REQUIRED SKILLS

    General Business/Communicating for Impact/ADVANCED

    Leadership/Driving a Culture of Compliance/ADVANCED

    Service/Providing Solutions to Constituent Needs/FOUNDATION

    DESIRED SKILLS

    Leadership/Collaborating for Results/ADVANCED

    Leadership/Creating Accountability/ADVANCED

    Service/Handling Service Challenges/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 and concise 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 is a plus.

    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