Job Description
Job Description
Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner post-service 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 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.
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 handling. Ensures all 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.
Required Qualifications
- 2+ years Aetna experience
- 1+ year Coaching experience
Preferred Qualifications
Medicare knowledge
Education
High school or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner post-service 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 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.
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 handling. Ensures all 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.
Required Qualifications
- 2+ years Aetna experience
- 1+ year Coaching experience
Preferred Qualifications
Medicare knowledge
Education
High school or equivalent.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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