Aetna Complaint & Appeal Anly in Phoenix, Arizona

Req ID: 37132BR


Responsible for managing to resolution complaint scenarios which may contain multiple issues and require coordination of responses. Ensure timely, customer focused response to complaints.

Fundamental Components:

1) Research incoming complaints to confirm appropriateness for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet complaint criteria.

2) Identify and research all components within member complaints for all products and services.

3) Triage incomplete components of complaints to appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response. (*)

4) Responsible for coordination of all components of complaints including final communication to member for final resolution and closure.

5) Identifies trends and emerging issues and reports on and gives input on potential solutions.

6) Follow up to assure complaint is handled within established timeframe to meet company and regulatory requirements.


1-2 years experience in customer service or auditing.

Must be organized and detail oriented.

Bachelor's Degree in psychology, counseling, social work preferred; will also consider comparable experience working in a local behavioral health setting.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Team environment where everyone works together. Interesting issue resolution and involvement with multiple areas of Mercy Maricopa Integrated Care and the State of Arizona AHCCCS system.

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.

Job Function: Risk Management