Aetna Supvr, Claim Operations in Houston, Texas

Req ID: 38281BR


Responsible for the daily activities and supervision of a team of employees supporting business segment functions, including but not limited to Claims processing, Customer Service, 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:

*Develops, trains, evaluates, and coaches staff/self to provide cost effective claim review/processing and claim service while ensuring quality standards are met.

*Acts as liaison between staff and other areas, including management, plan sponsors, provider teams, etc., communicating workflow results, ideas, and solutions

*Assesses individual and team performance on a regular basis and provides candid and timely developmental feedback. Develops training plans and ensures training needs are met

*Proactively analyzes claim/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

*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

*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

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

*May audit and adjudicate high dollar claims that exceed processor draft authority limits

*Utilize available incentive programs to reward, recognize, and celebrate team and individual's success

*Allocate resources to meet volume and performance standards including Key Performance Metrics (KPM's) and Performance Guarantees


2 years leading claim/customer service team.

Experience with claim/call center environment.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Functional - Claims/Claim processing - Medical - Medicare/4-6 Years


General Business/Communicating for Impact/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Leadership/Engaging and Developing People/ADVANCED


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Claim