Aetna VA MCD Exp Manager Service Operations in Richmond, Virginia
Req ID: 54342BR
(Only candidates willing to work in the Richmond VA office)
Responsible for increasing member and provider satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Maintains oversight of functions in local service center, including but not limited to customer service, claim, provider services, complaints, grievances, and appeals, implementation, and/or plan sponsor operations. Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Plans, directs and implements procedures that will assure a high level of customer access and satisfaction. Responsible for the quality and effectiveness of own team and related teams, identifying and resolving technical, operational and team problems. Manages a team of professional employees and/or supervisors.
Oversees the operations in a local service center handling a customer service function, which may include claims, member or provider services, billing, enrollment, accounts receivable and implementation services
Develops, monitors and reviews performance reports and service performance trends for each account against the plan and recommends specific actions or remedies as necessary
Develops and maintains strong collaborative relationships within operations as well as with patient management, Sales and Marketing, PSS, Underwriting, Utilization Management, and network management in establishing appropriate service level agreements
Develops, trains, evaluates, and coaches staff to provide cost effective claim processing and claim and customer service while ensuring that quality standards are met
Assesses individual and team performance on a regular basis and provide candid and timely developmental feedback; monitors training plans and ensure training needs are met
Establishes a clear vision aligned with company values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions
Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals; builds a cohesive team that works well together
Creates and maintains tools, job aids, and training materials to help employees in their efforts to resolve issues and improve their relationship with customers
Collects, analyzes and reports on operations information in support of process, systems, and policy redesign
Effectively applies and enforces Aetna HR policies and practices, i.e. FML/EML, Attendance, Code of Conduct, and Disciplinary Guidelines
Effectively manages cross-functional projects that support the business strategy
5+ years experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application program development
Healthcare experience preferred
Customer service experience preferred
Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes
Proven strong leadership skills managing large high performance teams
Experienced working with vendors. Demonstrated negotiation skills
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Additional Job Information:
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. 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.
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.
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: Customer Service
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.