Aetna Dir, Grievances & Appeals in Blue Bell, Pennsylvania

Req ID: 49751BR


. Position Summary/MissionDirects the grievance and appeals activities for a Health Plan and/or line of business that does business in multiple states. Ensures compliance with all state and federal grievance and appeals laws, the Centers for Medicare and Medicaid Services (CMS) regulations. Acts as primary liaison on appeal and grievance activities with all state Departments of Insurance. Develops and implements departmental policies and procedures. Oversight of Medicare Part C and D appeals teams.

Fundamental Components:

Provider day to day direction and oversight of the Part C and Part D appeals teams to ensure compliance and Star performance.


7-10 years experience directly related to the duties and responsibilities specified or an equivalent combination of education and work experience.

Previous supervisory and management experience required.

Previous Appeals Department experience preferred

Knowledge of all types of managed care products including HMO, PPO, and Medicare Part D

Demonstrated analytical skills and organization, with superior critical thinking and decision-making skills.

Demonstrated written and verbal communication skills. Able to present information to various audiences.

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.


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

Telework Specifications:

would like this position to be in Blue Bell, Moon Township or Green Tree.


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