Job Description:
• Manage staff responsible for resolving member or provider/practitioner post-service appeals
• Organize and develop high-performing teams to provide timely, customer-focused appeals responses
• Facilitate interfaces among team members and other business units
• Implement Aetna appeals policies and procedures
• Identify trends and issues; report findings and recommend solutions
• Manage team productivity and resources, communicate expectations, and balance workload
• Serve as a content model expert and mentor on Aetna policies, procedures, regulatory requirements, and accreditation requirements
• Manage quality, service, and cost-effectiveness performance measures
• Coach teams and individuals to take appropriate action
• Select staff using defined education, experience, technical, and performance requirements
• Build functional teams through training, assignments, coaching, mentoring, and development techniques
• Assess development needs and implement action plans for team and individual development
• Ensure appeals work meets federal and state requirements and quality measures, including letter content and turnaround time
• Ensure appeals units use the National tracking tool for consistent reporting and trend analysis
• Hold individuals and teams accountable for results and recognize or reward performance as appropriate
• Lead change efforts and manage team transitions
• Identify trends involving non-clinical issues and report findings and recommend solutions
Requirements:
• 4+ years of Aetna experience
• 2+ years of coaching experience
• Consistent availability for holiday/weekend coverage
• Less than 10% travel for leadership summits
• Bachelor's Degree or 4 years of equivalent work experience
• 2+ years of Medicare knowledge preferred
• 1+ years of leadership experience preferred
• 2+ years of claims knowledge preferred
• Project management experience preferred
• Colleague development experience preferred
• Ability to interpret and understand regulatory guidance and member contract materials
• Ability to oversee inventory with strict and short time constraints
• Ability to work in a fast-paced environment
Benefits:
• Base salary range of $46,988.00–$112,200.00 (the posting also repeats a $46,988.00–$102,000.00 range)
• CVS Health bonus, commission or short-term incentive program eligibility in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Work-from-home arrangement