Service Operations Manager - Medicaid & Medicare Claims (60178BR)Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
Opportunity will be office base in Phoenix.
(*) 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, CSRA, 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. Background Experience: (*) 5+ years’ experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application program development.
(*) Demonstrated negotiation skills.
(*) 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.
(*) Healthcare experience (Medicaid & Medicare) claims
(*) Experienced working with vendors
(*) Customer service experience.
(*) Bachelor's degree in a closely-related field, or equivalent experience. Required Skills: Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance, General Business - Demonstrating Business and Industry Acumen Desired Skills: Leadership - Engaging and Developing People, Service - Handling Service Challenges, Service - Working Across Boundaries Functional Skills: Claim - Claim processing - Medical - Medicare, Claim - Management: > 25 employees, General Management - Process & quality improvement, Management - Management - Claims Technology Experience: Desktop Tool - Microsoft PowerPoint, Desktop Tool - TE Microsoft Excel 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.
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