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Supvr, Complaint & Appeal

Company Name:
Aetna
Working At Aetna -- the Value To YouWhat does it mean to work at Aetna? A lot. From programs and benefits that support your financial, physical and emotional health to opportunities to build your knowledge and expand your career, the company makes working here a valuable experience in many ways.
POSITION SUMMARY
Responsible for managing CTM complaints for all products, which may contain multiple issues and require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints. Identify trends and emerging issues, report and recommend solutions.
Fundamental Components:
Responsible for the day-to-day management of staff to ensure effective, timely and customer-focused resolution of Medicare member and provider complaints. Oversee complaint investigation process; monitor regulatory compliance and accuracy of outcomes. Facilitate communication among team members and foster strong collaboration with other business units. Implement new processes that are compliant with Centers of Medicare & Medicaid Service (CMS) regulations as well as Aetna Medicare CTM policies and procedures. Identify complaint trends and issues; provide reports and recommend solutions as appropriate. Accountable for meeting the financial, operational, and quality objectives of the unit.
Strong knowledge of CMS systems (i.e., HPMS, MARx) as well Aetna Medicare-related systems (i.e., ASD, GEBAR, MOPS, etc.).
Ideal candidate will come from Aetna Medicare Service Operations.
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Required Skills:
BACKGROUND/EXPERIENCE desired:
Bachelor's degree or equivalent experience
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Leadership/Lead a complex or multifunctional organization/1-3 Years
Functional - Products-Medical/All Aetna Medicare Group Plans/1-3 Years
Functional - Management/Management - Medicare/1-3 Years
REQUIRED SKILLS
Leadership/Developing and Executing Strategy/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
Service/Handling Service Challenges/ADVANCED
DESIRED SKILLS
Finance/Delivering Profit and Performance/ADVANCED
Leadership/Driving Strategic and Organizational Agility/ADVANCED
Leadership/Engaging and Developing People/FOUNDATION
ADDITIONAL JOB INFORMATION
Ability to develop, train, evaluate and coach staff to ensure deadlines and quality standards are met.
Ability to act as liaison between staff and other departments to communicate results, ideas, and solutions.
Ability to assess individual and team performance on a regular basis and provides timely developmental feedback.
Ability to develop training plans and ensures training needs are met.
Ability to effectively apply and enforce Aetna HR polices and practices, i.e., FML/EML, Attendance, Code of Conduct, Disciplinary Guidelines.
Possesses excellent verbal and written communication skills.
Demonstrates ability to prioritize and multi-task in a fast-paced environment.
Establishes clear vision aligned with company values; motivates others to balance customer needs and business success.
Perform other duties and responsibilities as requested.
How to apply
Please use the "Apply" link to apply to this position. If you cannot view this link, you can find this position on our website by visiting: , click on apply online, search openings, and enter 20743BR in the keyword field. Additional information on what its like to work for Aetna and more can also be found on our website.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
No search firms please.
You will not be asked for personal information until you have been fully evaluated through Aetna's screening processes. Aetna will never ask applicants for money. If you want to verify the identity of someone who contacts you from Aetna, call 1-800-AETNAHR ( ).

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