Complaints Resolution Analyst, Hong Kong #51350BR
Aetna Inc.
Hong Kong, Hong Kong , US

Req ID : 51350BR

Requirements : · Responsible for investigating and resolving complaint and appeal scenarios for the Actisure and Open Health business platform, which may contain multiple issues, and the co-

ordination of a response that incorporates input from multiple business units, including external vendors.· Timely, customer-

focused response to complaints and appeals. · Review and analysis of plan documents, company policies, internal processes and regulatory requirements in order to make decisions and recommendations as to how to resolve issues.

  • Develop and maintain strong collaborative relationships with many operational areas, including but not limited to Member Services, Claims, Plan Sponsor Services, Compliance, Legal, Complaints Grievance & Appeals and external vendors.
  • Trend analysis on issues and recommended training and business solutions are expected.· Work closely with the Aetna International Compliance Team to identify and analyze route causes of complaints and appeals.
  • Responsible for producing management information for regulatory reports.· Working closely with the Compliance Team to produce timely reports and analysis statistics.
  • Managing multiple assignments, accurately and efficiently. · Build relationships while coordinating with multiple business units.
  • Identify complaint trends and issues and recommend business solutions. Required Competencies : · Excellent written and verbal communication skills· Strong organization, co-
  • ordination and prioritization skills· Good knowledge of health care processes · Ability to research claim processing logic to verify accuracy of claim payment, member eligibility data, billing-

    payment status, prior to initiation of complaint / appeal process · Ability to research standard plan design or certification of coverage pertinent to the member to determine accuracy, appropriateness of benefits and liability denial · Knowledge of legislation and regulations for the markets we operate in· Ability to influence a variety of business areas to resolve complaints and appeals within the local regulators required timeframes · Good utilization of Microsoft Office Software Skills and experience requirements : · Extensive knowledge of health claims processing.

  • excellent service by meeting quality and turnaround key performance metrics and meeting productivity expectations. · Excellent letter writing skills to convey a positive, professional image with our internal and external customers is essential.
  • Proven ability to produce and analyze complaint / appeal statistics and written reports relating to complaint handling, resolution and tracking.
  • Excellent quality results, analytical and communication skills. · Demonstrate the ability to build a strong internal network and effective influencing skills in order to recommend resolutions within regulatory timeframes.
  • Effective analysis skills to identify the complaint / service issue and recommend an appropriate resolution.· Knowledge of the legal and regulatory environment surrounding complaints and appeals.
  • Education : The highest level of education desired for candidates in this position is a bachelor s degree or equivalent experience. #LI-BR1

    Job Function : Risk Management

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