Aetna CA MCD Mgr, Member Services in San Diego, California

Req ID: 37941BR

California Medicaid, Manager, Member Services

The Manager, Member Services maintains oversight of functions in local service center. Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Plans, directs and implements procedures that will assure a high level of customer access and satisfaction. Responsible for the quality and effectiveness of own team and related teams, identifying and resolving technical, operational and team problems. Manages a team of professional employees and/or supervisors.

Fundamental Components:

(*) Develops, monitors and reviews performance reports and service performance trends against the plan requirements and recommends specific actions or remedies as necessary.

(*) Develops and maintains strong collaborative relationships within operations as well as with patient management, Sales and Marketing, Underwriting, Utilization Management, and network management in establishing appropriate service level agreements.

(*) Develops, trains, evaluates, and coaches staff to provide cost effective, first class customer service while ensuring that quality standards are met.

(*) Assesses individual and team performance on a regular basis and provide candid and timely developmental feedback; monitors training plans and ensure training needs are met

(*) Establishes a clear vision aligned with company values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions

(*) Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals; builds a cohesive team that works well together

(*) Creates and maintains tools, job aids, and training materials to help employees in their efforts to resolve issues and improve their relationship with customers

(*) Collects, analyzes and reports on operations information in support of process, systems, and policy redesign.

(*) Effectively manages cross-functional projects that support the business strategy.


(*) 5+ years experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application program development.

(*) California Healthcare experience preferred.

(*) Customer service experience required.


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


Functional - Administration / Operations/Management: < 25 employees/4-6 Years

Functional - Customer Service/Customer service - production environment/4-6 Years

Functional - Customer Service/Customer service - transaction based environment/4-6 Years

Functional - Customer Service/Management: < 25 employees/4-6 Years


Additional background, experience, knowledge and skills: Negotiation skills and well organized Proficiency with MS Office Suite, Excel, Word, PowerPoint, Share Point, Outlook, etc. Prioritizes tasks effectively Problem solving and critical thinking skills Strong project management skills (financial, analytical, planning and implementation) Demonstrated leadership skills Business knowledge including health care Highly organized and able to quickly prioritize multiple assignments with high quality results Ability to handle diverse assignments and juggle multiple priorities with ease Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management Experience with staff selection and development. Multiple years proven leadership experience managing a team, setting strategic direction and influencing change that resulted in quantifiable positive outcomes.

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: Customer Service