POSITION SUMMARY

Position Summary/Mission

Maintains oversight of functions in local service center, including but not limited to customer service, claim, provider services, complaints, grievances, and appeals, implementation, and/or plan sponsor operations. Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Plans, directs and implements procedures that will assure a high level of customer access and satisfaction. Responsible for the quality and effectiveness of own team and related teams, identifying and resolving technical, operational and team problems. Manages a team of professional employees and/or supervisors.

Fundamental Components:

Oversees the operations in a local service center handling a customer service function, which may include claims, member or provider services, billing, enrollment, accounts receivable and implementation services. (*)

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 and maintains strong collaborative relationships within operations as well as with patient management, Sales and Marketing, PSS, Underwriting, Utilization Management, and network management in establishing appropriate service level agreements. (*)

Develops, trains, evaluates, and coaches staff to provide cost effective claim processing and claim and customer service while ensuring that quality standards are met. (*)

Assesses individual and team performance on a regular basis and provide candid and timely developmental feedback; monitors training plans and ensure training needs are met. (*)

Establishes a clear vision aligned with company values; 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. (*)

Collects, analyzes and reports on operations information in support of process, systems, and policy redesign. (*)

Effectively applies and enforces Aetna HR policies and practices, i.e. FML/EML, Attendance, Code of Conduct, and Disciplinary Guidelines. (*)

Effectively manages cross-functional projects that support the business strategy. (*)

Exhibits the following Manager Behaviors

Performance Measures

BACKGROUND/EXPERIENCE desired:

5+ years experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application program development.Healthcare experience preferred. Customer service experience.

Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Customer Service/Call center monitoring & analysis - Inbound calls - call center location/1-3 Years

Functional - Management/Management - Customer Service/1-3 Years

ADDITIONAL JOB INFORMATION

Preferred Bilingual (Spanish)

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 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.

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Employment Type Regular

Career Band Description Management