Supervisor, Claim OperationsPrimary Location: Plantation, Florida
Additional Locations: FL-Plantation Apply
- Develops, trains, evaluates, and coaches staff/self to provide cost effective claim review/processing and claim service while ensuring quality standards are met.
- Acts as liaison between staff and other areas, including management, plan sponsors, provider teams, etc., communicating workflow results, ideas, and solutions.
- Assesses individual and team performance on a regular basis and provides candid and timely developmental feedback. Develops training plans and ensures training needs are met.
- Establishes clear vision aligned with company values; motivates others to balance customer needs and business success.
- Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.
- Proactively analyzes claim/constituent data, identifies trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.
- Leverages the unit's resources to resolve plan, claim and call inquiries or problems by identifying the issue, obtaining applicable information, perform root cause analysis, and generate and act upon the solutions.
- Develops and manages/operationalize a business plan that addresses immediate and longer-term business demands.
- Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center.
- Effectively applies and enforces Aetna HR polices and practices, i.e., FML/EML, Attendance, Code of Conduct, Disciplinary Guidelines.
- Ensures regulatory compliance with policies and procedures.
- May audit and adjudicate high dollar claims that exceed processor draft authority limits.
- Utilize available incentive programs to reward, recognize, and celebrate team and individual's success.
- Allocate resources to meet volume and performance standards including Key Performance Metrics (KPM's) and Performance Guarantees. Initiate and maintain partnerships with others throughout the Aetna organization and various vendors.
- Experience with claim/call center environment
- 2 years leading claim/customer service team
- Experience working with and managing vendors
- Solid written and oral communication skills.
- Strong project management skills (financial, analytical, planning and implementation).
- Solid leadership skills including staff development.
- Outstanding customer service skills are required.
- Prioritizes tasks effectively.
- Well organized.
- Negotiation skills.
- Technical skills.
- Problem solving skills.
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