Aetna Claims Manager in Jakarta, Indonesia

Req ID: 52950BR

Summary/MissionAchieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/MissionResponsible for the overall supervision of the Claim administrative employees. Accountable for member/provider/broker satisfaction, retention, and growth by efficiently delivering competitive services to members/providers Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)· Develops, trains, evaluates, and coaches staff/self to provide good claim administrative service while ensuring quality standards are met· Acts as liaison between staff and other areas, including management, plan sponsors, provider teams, etc., communicating workflow results, ideas, and solutions· Assesses individual and team performance on a regular basis and provides candid and timely developmental feedback. Develops training plans and ensures training needs are met· Establishes clear vision aligned with company values; motivates others to balance customer needs and business success· Attracts, selects, and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Builds a cohesive team that works well together· Proactively analyzes claim/constituent data, identifies trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives· Leverages the unit's resources to resolve plan, claim and call inquiries or problems by identifying the issue, obtaining applicable information, perform root cause analysis, and generate and act upon the solutions· Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center· Effectively applies and enforces HR polices and practices, Attendance, Code of Conduct, Disciplinary Guidelines· Ensures regulatory compliance with policies and procedures· Supports Complaints process as required· Utilizes available incentive programs to reward, recognize, and celebrate team and individual's success· Allocates resources to meet volume and performance standards including Key Performance Metrics (KPM's) and Performance Guarantees· Initiates and maintains partnerships with others throughout the organization and various vendors· Ensures compliance with requirements of regional compliance authority/industry regulator· Adheres to international privacy policies, practices and procedures Background/Experience Desired· 3+ years claims processing experience.· Experience with claim/call center environment. Education and Certification Requirements· Higher education or local market equivalent.· University/college degree preferable or equivalent work experience. Additional Information (situational competencies, skills, work location requirements, etc.)· Technical skills.· Negotiation skills.· Well organized.· Prioritizes tasks effectively.· Problem solving skills.· Outstanding customer service skills are required.· Strong project management skills (financial, analytical, planning and implementation).· Solid written and oral communication skills.· Solid leadership skills including staff development

Job Function: Claim