Aetna Complaint and Appeals Analyst in Phoenix, Arizona
Req ID: 64360BR
The Complaint Analyst is responsible for working member grievances (complaints) within required timeframes, from intake to resolution. The review process could require coordination with multiple internal departments at the health plan as well as medical providers or other delegated entities. The Complaint Analyst is responsible for managing the lifecycle of the case and communicating the final resolution to the member or authorized representative.
Fundamental Components included but are not limited to:
Acknowledge and respond to member complaints, orally or in writing
Coordinate issue resolution among multiple departments within required time frame
Provide guidance/coaching to frontline staff on specific cases
Identify and trend systemic problems and make suggestions to improve or reduce the possibility of a reoccurrence
Ensure the resolution appropriately addresses all issues raised in the complaint
Communicate issue resolution, orally or in writing
Monitor timeliness and ensure compliance with case work
Qualifications Requirements and Preferences:
Strong verbal/written communication skills required.
1-3 years' experience in customer service & handling complaints
Ability to deescalate difficult situations while displaying compassion and empathy
Ensure each issues was reviewed appropriately prior to resolution
Well organized with ability to manage, prioritize & meet deadlines of cases
Experience with claims and benefits a plus
Customer Service - FE Complaints, grievances & appeals
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Creating Accountability
Service - Demonstrating Service Discipline, Service - Handling Service Challenges, Technology - Leveraging Technology
Additional Job Information:
Ability to communicate effectively and document accordingly.
Behavioral health, Medicare and Medicaid experience a plus.
Ability to handle difficult callers and while maintaining composure. Ability to multi-task using several different websites to obtain information.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Risk Management
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.