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Complaint and Appeal Analyst

Company Name:
Aetna
Req ID: 16257BR
POSITION SUMMARY
Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to complaints/appeals. Identify trends and emerging issues and report and recommend solutions.Seeking a candidate with strong Claims background. In addition, medical terminology and appeals and grievance experience required. Attention to detail is a must as this department processes large volumes with contractual timeframes.
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 - Claims/Claim processing - Medical or Hospital- HMO/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Database/Microsoft Access/1-3 Years/End User
REQUIRED SKILLS
Service/Demonstrating Service Discipline/FOUNDATION
General Business/Turning Data into Information/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
DESIRED SKILLS
Service/Handling Service Challenges/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
ADDITIONAL JOB INFORMATION
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function: Risk Management

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