[Hiring] Associate Manager, Complaints & Appeals @CVS Health

Role Description

Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner post-service appeals. Key responsibilities include:

• Organization and development of high performing teams to ensure timely, customer-focused response to appeals.
• Facilitating effective interfaces among team members and other business units.
• Day-to-day implementation of Aetna's appeals policies and procedures.
• Identifying trends and issues; reporting on and recommending solutions.
• Accountability for meeting financial, operational, and quality objectives of the unit.
• Managing team's productivity and resources, communicating productivity expectations, and balancing workload to achieve customer satisfaction.
• Serving as a content model expert and mentor regarding Aetna's policies and procedures, regulatory and accreditation requirements.
• Managing performance measures and standards for quality service and cost-effectiveness.
• Coaching the team/individuals to take appropriate action.
• Selecting staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Building strong functional teams through formal training, diverse assignments, coaching, mentoring, and other developmental techniques.
• Assessing developmental needs and collaborating to implement action plans that support high-performing teams and individuals.
• Ensuring work of team meets federal and state requirements and quality measures.
• Ensuring all appeals units utilize the National tracking tool for reporting consistency and trend analysis.
• Holding individuals/team accountable for results; recognizing/rewarding as appropriate.
• Leading change efforts while managing transitions within a team.
• Identifying trends involving non-clinical issues and reporting on and recommending solutions.

Qualifications

• 4+ years Aetna experience
• 2+ years Coaching experience
• Schedule consistency of holiday/weekend coverage
• Less than 10% travel for leadership summits

Requirements

• 2+ years of Medicare Knowledge
• 1+ years Leadership experience
• 2+ years of Claims Knowledge
• Project Management - Colleague development
• Ability to interpret and understand Regulatory Guidance, Member Contract Materials
• Oversight over inventory with strict and short time constraints in a fast-paced environment

Education

• Bachelor's Degree or 4 years of equivalent work experience

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources based on eligibility

Pay Range

The typical pay range for this role is: $46,988.00 - $112,200.00. The actual base salary offer will depend on various factors including experience, education, geography, and other relevant factors.

Anticipated Weekly Hours

40