Medicaid Appeals & Grievance Associate Manager
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Salary
💰 $46,988 - $102,000 per year
About the role
- Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances.
- Responsible for day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals, complaints and grievances for all products.
- Ensure timely, customer focused response to appeals, complaints and grievances.
- Responsible for day-to-day implementation of Aetna's appeals, complaints and grievances policies and procedures.
- Identifies trends and issues; reports on and recommends solutions.
- Accountable for meeting the financial, operational, and quality objectives of the unit.
- Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns.
- Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements.
- Manages to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action.
- Participation in the staff selection process using clearly defined requirements in terms of education, experience, technical and performance skills.
- Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques.
- Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals.
- Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turn-around time for appeals, complaints and grievances handling.
- Holds individuals/team accountable for results; recognize/reward as appropriate.
- Lead change efforts while managing transitions within a team.
- Identifies trends and emerging issues and reports on and gives input on potential solutions.
Requirements
- Experience in reading or researching benefit language.
- Excellent verbal and written communication skills.
- Solid project management skills.
- Excellent customer service skills.
- Experience documenting workflows and reengineering efforts.
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
project managementworkflow documentationreengineering
Soft Skills
communicationcustomer serviceteam managementmentoringcoachingproblem-solvingtrend analysisaccountabilitychange management