Aetna Veterans Jobs

Job Information

Aetna Complaint and Appeals Analyst in Phoenix, Arizona

Req ID: 64360BR

Job Description

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

Functional Skills:

Customer Service - FE Complaints, grievances & appeals

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Required Skills:

General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Creating Accountability

Desired Skills:

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

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.