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.
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
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
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
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
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
General Business/Communicating for Impact/ADVANCED
Leadership/Driving a Culture of Compliance/ADVANCED
Service/Providing Solutions to Constituent Needs/FOUNDATION
Leadership/Collaborating for Results/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