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Supervisor, Complaint & Appeal

Primary Location: Arlington, TX
Additional Locations: TX-Arlington
Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner complaints/appeals. Responsible for organization and development of high performing teams to ensure timely, customer focused response to appeals. Facilitates effective interfaces among team members, as well as, other business units. Responsible for day-to-day implementation of Aetna's complaints and appeals policies and procedures. Identifies trends and issues; reports on and recommends solutions. Accountable for meeting the financial, operational, and quality objectives of the unit.

No nights.
Weekends & holidays as needed.
Standard business hours Monday-Friday.

Fundamental Components:
Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns.Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements.Manages to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action.Select staff using clearly defined requirements in terms of education, experience, technical and performance skills.Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals.Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turn-around time for Appeals and Complaints handling.Ensures all Complaints and Appeals units are utilizing the National tracking tool to ensure reporting consistency and trend analysis.Holds individuals/team accountable for results; recognize/reward as appropriate.Lead change efforts while managing transitions within a team.Identifies trends involving non-clinical issues and reports on and recommends solutions.Additional duties as assigned, (e.g., Supervisors with less than 15 direct reports will also handle resolution work the % of the time they are not managing their staff).

Background Experience:
3 years of healthcare leadership experience
Excellent verbal and written communication skills.
3 years project management experience
Excellent customer service skills
Experience documenting workflows and reengineering efforts.
3 years experience with claim/call center environment.
Prefers complaint & appeals experience.

Bachelor's degree or equivalent experience.

Additional Job Information:
Maintains joint ownership throughout all phases of business system or technology delivery and beyond.Ability to work across Aetna functions, segments and markets to accomplish business goals.Ability to multi-task to accomplish workload efficiently.Ability to assess return on value of proposed solutions and select option of greatest value.Ability to revise priorities as appropriate to respond to change.Ability to identify options that add value to constituents.Excellent verbal and written communication skills.

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)


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