Aetna Technical Claims Manager in Farnborough, United States
Req ID: 51405BR
About AetnaAetna International is a leading provider of international expatriate private medical insurance and health management solutions. We have over 1000 staff and growing every day. Our customer base is over 123,000 members located worldwide; and we have more than 71,000 health care professionals and facilities worldwide in the offices in all the major regions of the world. Role SummaryTo provide technical management support to the Claims areas ensuring that the technical claims operation is controlled in accordance with policy provisions, company and regulatory requirements, globally team’s processes are highly efficient and remain consistent. Provide support and assistance as required to the Head of Technical Claims in order to support delivery of strategic projects as well as day to day delivery of excellent customer service. Also will assist in developing a strategic direction for the claims organization.Responsibilities of the Role• Assists in developing a vision, direction and strategy for the claims organization that meets with our corporate strategy in conjunction with the Head of Technical Claims and the Head of Claims & Service.• Ensures consistent and quality claims assessment within all claims operation centers, vendors and TPAs.• Be the first point of contact for any escalated technical claim referrals over the regional Claims Manager’s limits.• Manages the relevant referral mailboxes and work queues in respect to the workload.• Works closely with the regional Claims Managers and Vendors to develop the optimal claims workflow and processes to optimize the performance of the claims organization.• Oversee complex and high cost claims and provide advice/guidance where required.• Conducts internal and external technical audits in line with the Claims audit timetable and complete a report with findings and recommendations.• Manages complex complaints and legal disputes within limit.• Assists in the monitoring and analysis of complaints and QA errors and participates in the discussions for the same with the regional Claims Managers and Head of Technical Claims.• Assists in staff training as and when requested by the Head of Technical Claims.• Assists in carrying out due diligence for new ventures as necessary.• Reviews and analyses Management Information to maximize the efficiency of working practices, procedures and protocols.• Ensures best practice is applied from a quality control perspective with regional areas achieving a minimum of 97% accuracy rates on technical and decision making.• Advises/recommends policy wording enhancements.• Maintains up to date market awareness.• Assists in implementing projects as advised by the Head of Technical Claims. Background/Experience Desired• 3 years or more of claims management experience with responsibility for all areas of medical claims handling• Extensive knowledge of all areas of claims handling• Demonstrated strategic and critical thinking skills• Excellent written, verbal, and overall people management skills.• Experience with claims technology and leading industry practices• PC LiterateEducation and Certification RequirementsDegree and/or equivalent work experience is required.Additional Information (situational competencies, skills, work location requirements, etc.)• Excellent communication skills, written and verbal.• Ability to explain concepts simply and unambiguously.• Organized and able to prioritize.• Ability to deal with high work volumes.
Job Function: Claim