Aetna Manager, Medicare Grievance in San Antonio, Texas

Req ID: 52145BR

POSITION SUMMARY

The Grievance Manager is responsible for establishing and maintaining consistent policies and procedures to ensure compliant investigation and resolution to grievances received from Aetna Medicare members. Reviews root cause data, identifies trends, raises awareness and recommends solutions. Monitors, coaches, and develops supervisors. Collaborates and partners with peers, members of management and business partners.

FUNDAMENTAL COMPONENTS:

Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/compliant handling of member grievances

Serves as a subject matter expert and mentor to team in regards to Aetna's policies and procedures, regulatory and Medicare requirements

Manages to performance measures and standards for quality service and cost effectiveness and coaches 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 Medicare requirements and quality measures

Contribute measurable progress to the achievement of our business units employee engagement survey results and diversity scorecard goals

Contribute to successful Medicare and Compliance audit results

BACKGROUND/EXPERIENCE DESIRED:

1-3 years supervisory experience

1-3 years Medicare experience in research and analysis of complaint processing, or experience with internal Aetna systems required.

Experience working with Medicare benefits and/or customer service required.

Excellent verbal and written communication skills

Knowledge of Medicare terminology, regulatory and compliance requirements

Product knowledge and experience with grievance requirements including Chapters 13 and 18

Strong analytical skills focusing on accuracy and attention to detail

Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Management/Management - Medicare/1-3 Years

Customer Service/Customer Service - Member Services - HMO products/1-3 Years

TECHNOLOGY EXPERIENCES

Desktop Tools/Microsoft Outlook/1-3 Years/End User

Desktop Tools/Microsoft SharePoint/1-3 Years/End User

REQUIRED SKILLS

Leadership/Driving a Culture of Compliance/ADVANCED

General Business/Communicating for Impact/ADVANCED

Leadership/Engaging and Developing People/ADVANCED

Experience working with Medicare benefits and/or customer service required

1-3 years Medicare experience in research and analysis of complaint processing, or experience with internal Aetna systems required.

DESIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

Leadership/Driving Change/ADVANCED

Service/Handling Service Challenges/ADVANCED

ADDITIONAL JOB INFORMATION

Will manage a team of approximately 8 supervisors that will be located in all time zones. At times of the year when business needs require overtime of our analysts, the management team is required to work the same amount of additional hours. (weekdays and weekends) Grievance managers are also responsible for case handling and other inventory related tasks as need through the year when business needs require it. Flexible schedule, casual attire, great opportunity to learn healthcare operations and gain exposure to cross functional teams.

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.

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.

Job Function: Risk Management