Associate Manager, Complaints & Appeals

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner post-service appeals • Responsible for organization and development of high performing teams • Facilitates effective interfaces among team members, as well as, other business units • Responsible for day-to-day implementation of Aetna's appeals 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 • Serves as a content model expert and mentor to team regarding Aetna's policies and procedures • Manages to performance measures and standards for quality service and cost effectiveness

🎯 Requirements

• 4+ years Aetna experience • 2+ year Coaching experience • Schedule consistence of holiday/ weekend coverage • Less than 10% of travel for leadership summits • 2+ years of Medicare Knowledge (preferred) • 1+ years Leadership experience (preferred) • 2+ years of Claims Knowledge (preferred) • Project Management (preferred) • Colleague development (preferred) • Ability to interpret and understand Regulatory Guidance, Member Contract Materials (preferred)

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • short-term incentive program