The individual in this position will be responsible for a team that provides service to our Local Markets Southeast customers. Maintains oversight of functions in local service center, including but not limited to claim service operations. Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Responsible for overall supervision of the claim processing employees. Accountable for member/provider satisfaction, retention, and growth by efficiently delivering competitive services to members/providers.
Oversees the operations in a local service center handling claims processing function. 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 trains, evaluates, and coaches staff on a regular basis and provide candid and timely developmental feedback; monitors training plans and ensure training needs are met. Utilizes available incentive programs to reward, recognize and celebrate team and individual success. Establishes a clear vision aligned with company values and Our Common Purpose; 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. Effectively manages or participates in cross-functional projects that support the business strategy. Acts as liaison between staff and other areas, including management, all segments, and provider teams. Effectively applies and enforces Aetna HR policies and practices, i.e. FML/EML, Attendance, Code of Conduct, Disciplinary guidelines. Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives. Leverages the unit's resources to resolve plan, claim and call inquiries or problems by identifying root cause analysis, and generate and act upon the solutions. 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. May audit and adjudicate high dollar claims that exceed processor draft authority limits.
2+ years claims experience and in managing high volume transaction processing, production. Healthcare experience preferred. Customer services experience a plus. Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes. Proven strong leadership skills
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Functional - Claims/Claim processing - Medical or Hospital- HMO/1-3 Years
Functional - Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Technical - Aetna Applications/Automated Claim Adjudication System/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
General Business/Maximizing Work Practices/ADVANCED
Leadership/Creating a World Class Workforce/ADVANCED
Leadership/Engaging and Developing People/ADVANCED
Leadership/Driving a Culture of Compliance/ADVANCED
ADDITIONAL JOB INFORMATION
This position is a great opportunity for someone with good leadership skills, ability to manage a high performance team and development of staff and talent to leverage these skills to the next level in our organization. The candidate will be able to expand their network of people internally and externally to develop a different level of relationship and collaboration. They will be able to influence strategic direction and processes on how we delivery service.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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