Associate Manager, Complaints & Appeals

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee staff tasked with addressing member or provider/practitioner post-service appeals

• Develop and organize high-performing teams to ensure prompt, customer-centered responses to appeals

• Facilitate collaboration among team members and other business units

• Execute Aetna's appeals policies and procedures

• Identify trends and issues; present findings and suggest solutions

• Manage team productivity and resources, communicate expectations, and balance workloads

• Act as a subject matter expert and mentor on Aetna policies, procedures, regulatory standards, and accreditation requirements

• Oversee quality, service, and cost-effectiveness performance metrics

• Guide teams and individuals to take suitable actions

• Select staff based on established educational, experiential, technical, and performance criteria

• Build functional teams through training, assignments, mentoring, and development strategies

• Evaluate development needs and implement action plans for team and individual growth

• Ensure that appeals work complies with federal and state standards and quality measures, including letter content and response times

• Ensure that appeals units utilize the National tracking tool for consistent reporting and trend analysis

• Hold individuals and teams accountable for their outcomes and acknowledge or reward performance as necessary

• Lead change initiatives and manage transitions within the team

• Identify trends related to non-clinical issues and report findings while recommending solutions

⛳️ Requirements

• At least 4 years of experience with Aetna

• Minimum of 2 years of coaching experience

• Regular availability for holiday and weekend coverage

• Less than 10% travel required for leadership summits

• Bachelor’s Degree or 4 years of equivalent professional experience

• Preferred: 2+ years of knowledge related to Medicare

• Preferred: 1+ years of leadership experience

• Preferred: 2+ years of experience with claims

• Preferred: Project management experience

• Preferred: Experience in colleague development

• Ability to interpret and understand regulatory guidelines and member contract materials

• Capability to manage inventory under strict and tight deadlines

• Capacity to thrive in a fast-paced environment

🏝️ Benefits

• Base salary range of $46,988.00–$112,200.00 (also stated as a $46,988.00–$102,000.00 range)

• Eligibility for CVS Health bonus, commission, or short-term incentive programs in addition to base salary

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial wellness

• Work-from-home arrangement