Supervisor, Complaint & Appeals

Job DescriptionResponsible 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 Qualifications2+ years Aetna experience- 1+ year Coaching experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsMedicare background, leadership skillsEducationHigh School, GED, or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19