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Aetna is now a CVS Health Company

Complaint and Appeals Analyst

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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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:
  • 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



Background Experience:
  • 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


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.


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

Functional Skills:
Customer Service - FE Complaints, grievances & appeals

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Potential Telework Position:
No

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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