上海招聘

某国际健康保险公司

Family Summary/Mission:
To increase member and provider satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated vendor organizations, staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.

Position Summary/Mission:
This position is responsible for Claim, Call and Correspondence workload management, as well as inventory management across Aetna and vendor staff, trending and reporting and quality management. The goal of this position is to ensure claim, call and correspondence work is distributed appropriately across available resources and that turnaround time and quality goals are met in accordance with plan policies, procedures and agreed service levels.

Fundamental Components & Physical Requirements:
?Develop, monitor and review performance reports and contact the vendor Supervisor regarding aged work.
?Follow up with the vendor to manage their work.
?Monitor backlogs for increased incoming claim, call or correspondence volume.
?Monitor rework and fastrack work queues to ensure turn around time goals are met.
?Complete weekly backlog reports and all turn around time reports.
?Develop, produce and review performance exception reports.
?Manage all backlogs with the vendor.
?Formulate, affect, interpret, or implement management policies or operating practices.
?Develop and maintain workflows that govern the management of work for claims processors and customer service representatives.
?Assist with planning long- and short-term business objectives.
?Provide input on appropriate vendor selection.
?Provide guidance as to what work should be handled by each AGB or vendor team.
?Investigate and resolve matters of significance on behalf of management.
?Review escalated service issues, undertake specific claim reviews as needed, and provide guidance on reports and tools available for Actuary.
?Hold frequent performance review sessions with the Vendor management teams.
?Remove vendor resources from handling work if performance is unacceptable.
?Ensure complaints are satisfactorily investigated and resolved within required regulatory timeframes.
?Manage internal workflows to ensure internal turnaround times and service levels are met by Aetna colleagues.
?Analyze error reports and resolve error trends
Coordinate the vendor claim review/rebuttal process with supervisory staff
Provide rework analysis to improve site/vendor quality results
?Review and update process workflows to ensure good practice and efficiencies are maintained.
?Monitor the quality of the vendor performance to ensure quality and performance targets are met and deal with any missed targets.
?Produce and analyse management information reports to demonstrate and monitor vendor performance in accordance with performance targets and identify trends, and circulate these reports to all interested parties.
?Develop and maintain strong collaborative relationships
?Effectively manages cross-functional projects that support the business strategy

Background/Experience Desired:
?Management experience preferred
?Vendor or relationship management experience preferred

Educational Requirements:
?Bachelor's degree or equivalent work experience
?Advanced degree preferred

Additional Information (not mandatory to complete):
?Negotiation skills.
?Well organized.
?Prioritizes tasks effectively.
?Strong influencing skills
?Problem solving skills.
?Strong project management skills (financial, analytical, planning and implementation).
?Solid written and oral communication skills.
?Strong infuencing skills
?Critical problem solving ability
?Highly organized and able to quickly prioritize multiple assignments with high quality results.
?Ability to handle diverse assignments and juggle multiple priorities with ease.
?Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management and vendors.
?Experience with staff selection and development.

  开胜咨询专注企业管理综合服务行业10余年，提供各类高端企业管理项目服务、人才发展咨询服务、企业培训服务、业务外包服务等专项服务，先后服务了上千家国企、外企与民企。
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  海外业务涉及：英国、越南、美国 ；
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  开胜咨询有限公司以“专业领先、追求卓越“为企业理念，其所经营的各业态领域中均拥有强大的专家团队，为客户提供独立领域专业咨询服务和开胜独特的集团式联动咨询服务。