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Claims Supervisor

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Job Details
Job Order Number
Company Name
Physical Address

Newark, DE 19725
Job Description

Req ID: 68218BR

Job Description

Responsible for the daily activities and supervision of a team of employees supporting business segment functions, including but not limited to customer service, claim, provider services, complaints, grievances, and appeals, implementation, and/or plan sponsor operations. Responsible for the quality, efficiency and effectiveness of own team, identifying and resolving routine problems. Sets priorities for and coaches employees to meet goals.

Fundamental Components included but are not limited to:

+ Develops, motivates, evaluates and coaches staff on work procedures, proper call handling and teamwork delivering excellent customer service.

+ Is visible and available to staff to answers questions, monitor calls and give ongoing feedback.

+ Utilizes available incentive programs to reward, recognize and celebrate team and individual successes.

+ Assesses individual and team performance on a regular basis and provide candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards.

+ Establishes clear vision aligned with company values; motivates others to balance customer needs and business success.

+ Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center.

+ Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.

+ Leverages the unit’s resources to resolve plan, claim and call inquiries or problems by identifying the issue, obtaining applicable information, perform root cause analysis, and generate and act upon the solutions.

+ Remove barriers to job performance and ensures regulatory compliance.

+ Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.

+ Acts as liaison between staff and other areas, including management, all segments, provider teams, etc., communicating workflow results, ideas, and solutions. Proactively analyzes constituent data, identifies trends and issues.

+ Recognizes and acts on the needs to improve the development and delivery of products and services.

+ Clearly identifies what must be accomplished for successful completion of business objectives.

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

Qualifications Requirements and Preferences:

+ 3 – 5+ years experience in managing high volume transaction processing.

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

+ Proven strong leadership skills managing large high performance teams.

+ Healthcare experience preferred.Customer service experience.

+ Bachelor’s degree in a closely-related field, or equivalent combination of education and experience.Advanced degree preferred.

Functional Skills:

Claim – Claim processing – Medical – Behavioral Health, Claim – Claim processing – Medical – Medicare, Claim – Claim processing – Medical or Hospital – ACAS

Required Skills:

General Business – Applying Reasoned Judgment, General Business – Communicating for Impact, General Business – Consulting for Solutions, General Business – Demonstrating Business and Industry Acumen, General Business – Maximizing Work Practices, Leadership – Driving a Culture of Compliance, Leadership – Driving Change

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Customer Service

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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