Aetna Complaint & Appeal Anly in Moon township, Pennsylvania

Req ID: 51355BR


Seeking organized and motivated individuals to join the Medicare Complaints team as a CTM Analyst. CTM analysts are responsible for investigating and resolving complaints filed by members regarding their benefits or service experience. The complaint may contain multiple issues requiring coordination across multiple business units. Analysts must ensure timely, customer focused responses to complaints both orally and in writing. They are also expected to identify trends and emerging issues as they review complaints.

Fundamental Components:

Review of contract materials; Interpret Medicare Regulations and Guidance; Strong written and verbal communication skills; Draft letters to members in a clear and concise manner; Update internal system, documenting the activity of case file review with clarity and accuracy - Maintain accountability for resolving each case within established internal timeframes - Recognize trends and provide solutions


2-3 years Medicare experience is a plus - 2-3 years Customer Service experience is a plus - Candidate should have medical claims, benefit and prescription drug knowledge. Ability to navigate through Aetnas systems is a plus- Must resolve each and every case in accordance with the regulatory timeframes and guidance.


The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.


Functional - Customer Service//1-3 Years

Functional - Products-Other//1-3 Years

Functional - Quality Management//1-3 Years

Functional - Claims//1-3 Years


Technical - Aetna Applications///

Technical - Computer Operations///


Flexible work schedule with potential to work at home on occasion after an extended period of successful performance. If you have a heart for working with the Medicare population and enjoy solving complex problems this is a rewarding position where you can learn healthcare operations. Casual dress/atmosphere and free parking.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Risk Management