Aetna Plan Documents Quality and Tra in Amherst, New York

Req ID: 50841BR


Serves as the Team Lead in the Quality and Training department for Plan Documents of a benefits administration company. In this role the successful candidate will manage the internal quality and training of the Plan Document team. They will lead development and maintenance of quality scoring, controls and procedures; provides regular employee coaching & mentoring; development and maintenance of departmental reference materials.

Fundamental Components:

Conduct standard quality review/audits of Plan Documents, Amendments, and Summaries of Benefits and Coverage to measure compliance with published policies, procedures, customer and regulatory guidelines. Additionally responsible to support targeted quality audit projects.

Develop and implement quality programs and initiatives. Identify and recommend internal and external benchmarks and appropriate measures for performance evaluation.

Develops, trains, evaluates, and coaches staff to provide cost effective decisions within Client Regulatory Affairs and Risk Management while ensuring operating standards are met; continually assesses individual and team performance against key business objectives and provides candid and timely developmental feedback.

Mentors, coaches and assists with the training for staff regarding benefit language, software navigation and provides technical expertise critical for achieving key performance measures.

Collaborates cross-functionally as well as cross-departmentally to achieve business goals; influences change/enhancement to business processes, policies and system infrastructure to improve information quality, availability, and access.

Reports results and make recommendations regarding training needs, process improvement and quality controls and procedures.

Creates and updates training documentation such as training outlies, manuals, job aids and other materials.

Coordinate, schedule and facilitate training sessions for new and existing team members.

Basic understanding of regulations, laws, and internal procedures impacting self-funded health plans with attention to ensuring the plan and company remain in compliance with federal and state law.

May participate in implementation of department projects as needed.

Other duties as assigned, requested or required.


Demonstrates ability to train others by sharing knowledge

Demonstrates critical thinking and analytical ability

Demonstrates aptitude to develop people and processes

Experience in an audit/quality review environment

Plan writing experience supporting self-funded or fully insured plans.

Interpersonal skills to include written and verbal communication, critical thinking, persuasiveness, advising and counseling skills.

Effective time management, organizational and prioritization skills.

Able to effectively motivate others and lead change and innovation.

Strong attention to detail and accuracy performing at high levels in a fast paced and constantly changing work environment.

Ability to give and receive constructive feedback.

Proficiency with Microsoft Office Word, Excel, SharePoint and Outlook applications.


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


Functional - Administration / Operations/Document production & distribution/1-3 Years

Functional - Customer Service/Customer Service - Plan Sponsor - Contract installation & maintenance/1-3 Years

Functional - Communications/Communication Quality Control/1-3 Years

Functional - Learning/Principals of Adult Learning/1-3 Years


General Business/Communicating for Impact/ADVANCED

Service/Demonstrating Service Discipline/ADVANCED

Technology/Selecting and Applying Technology Solutions/FOUNDATION


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.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Customer Service