Aetna Federal Health Plans Business Operations Senior Project Manager in Downers Grove, Illinois
Req ID: 49620BR
As part of the Aetna Federal Plans Business Operations team, this position will have the responsibility to know plan benefits, manage ongoing projects related to member appeals and related communication with the federal government, manage Call Campaigns for member outreach, support the annual RPF proposal process for the federal government and operational support for enrollment files and periodic quality audits. Job involves working closely with other areas of the team such as service operations, marketing, medical & plan policy, legal/compliance and communications. This position will manage multiple projects concurrently and requires the ability to keep all efforts moving toward resolution in a timely manner.
(*) Develop knowledge of Federal Plans and associated benefits. Operational knowledge of key application systems and plan administration
(*) Supporting enrollment validation and quarterly audits for Medicare assignment.
(*) Assisting with requests for information from the federal government as well as reviewing escalated member appeals.
(*) Identifying opportunities for streamlining process to improve efficiency and quality
(*) Key operational support for annual federal government RFP process including coordinating responses to key components
(*) Taking on additional projects as needed and seeking out ways to improve processes to achieve business goals. -
Communicating well both internally and externally to find solutions and resolve issues quickly, collaborating with other businesses as needed
(*) Completing reporting needs as necessary to review audit results, trends, campaign results, appeals summary
(*) Work collaboratively with internal/external constituents on quality reviews, audits and other projects
(*) Demonstrating a willingness to accept change and adjust well to new situations while demonstrating initiative and innovation to achieve results. Must think from the consumer and the customer (Government) perspective.
(*) Complies with the laws, regulations and ethical standards that govern the business.
(*) Proven track record in meeting project milestones and negotiating for resources.
(*) Proven communication skills both written and verbal
(*) Past positions required acting a project lead and directing a team
(*) Proven ability to affect change/interpersonal skills
(*) Solid Project Management skills
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Information technology/Microsoft Office PowerPoint is desired
Information technology/Microsoft Excel is desired
Functional - Project Management/Project Leader/4-6 Years
Functional - Project Management/Cross-functional project management/4-6 Years
Functional - Management/Management - Process and quality improvement/4-6 Years
Leadership/Collaborating for Results/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
General Business/Applying Reasoned Judgment/MASTERY
General Business/Communicating for Impact/ADVANCED
General Business/Ensuring Project Discipline/MASTERY
-Option for telework will be evaluated after a certain period of employment
-Telework considered only for unique circumstances
ADDITIONAL JOB INFORMATION
A great opportunity to learn about Health Plan operations and engage with multiple teams that are responsible for various aspects of plan administration.
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: Management