Aetna Claims and Vendor Manager - 49348BR in Dubai, United Arab Emirates

Req ID: 49348BR

Family Summary

To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.

Position Summary

Maintains oversight of Claims functions in multiple service centers for a defined region with direct staff reporting to them that support claims in addition to responsibility for work done by Vendor staff.

This positions internally links to internal teams, including claim payments, claim rework, member or provider inquiries, billing, enrollment, accounts receivable, and/or implementation services.

Executes strategic and operational plans in support of business segment customer services objectives and initiatives. Sets business area priorities, allocates resources and develops plans for multiple related teams. Ensures all critical service metrics and operational results are achieved. Leads multiple managers, highly specialized professional staff or significant outsourced operations.

Fundamental Requirements

  • Oversees the operations of multiple service centers in different locations handling a Claims service function .

  • Utilizing expert knowledge to oversee operating systems including policies and procedures, operating structure, and information flow across multiple service centers.

  • Directs implementation of Claims service standards for each location to ensure delivery of quality-focused, consistent cost effective service and administration both in-house and for work administered by vendors.

  • Analyzes operational practices for effectiveness and practicality, while creating a culture which is innovative in its approach to solutions.

  • Establishes a clear vision aligned with company values; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs, budgets, and business success.

  • Develops an organization that attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals; builds a cohesive team that works well together and across other business segment functions.

  • Effectively and proactively manages to budget, analyzing and acting upon financial variances from plan by identifying additional cost saving strategies.

  • Validates production billing volumes and rates across the global platform. Leads and builds high performance teams across units by providing leadership, mentoring and coaching in achieving understanding of the voice of the customer.

  • Accountable for leading staff in accordance with Aetna s standards of leadership excellence.

  • Monitors and evaluates service center operational plans ensuring customer service standards are maintained during facility shutdowns (anticipated or unanticipated) and during business activity transfers between locations.

  • Coordinates major plan modifications necessitated by unanticipated business or technology developments.

  • Develops and implements business strategies to provide accurate and proactive customer service to members, plan sponsors and brokers aligned to service center. Provides operational support for market management of plan sponsors, members and network providers.

  • Ensures compliance outcomes are included in all plans and goals.

Background/Experience Desired

  • 5+ years experience in managing high volume claims processing,financial management, project delivery, and production

  • Healthcare / Medical Insurance experience essential.

  • Customer service experience.

  • Multiple years proven leadership experience setting strategic directionand influencing change that resulted in quantifiable positive outcomes.

  • Experienced working with vendors is highly desirable.

  • Demonstrated negotiation skills.

Education and Certification Requirements

  • Bachelor's degree in a closely-related field, or equivalent combinationof education and experience.

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Job Function: Customer Service