• Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances. • Responsible for day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals, complaints and grievances for all products. • Ensure timely, customer focused response to appeals, complaints and grievances. • Responsible for day-to-day implementation of Aetna's appeals, complaints and grievances policies and procedures. • Identifies trends and issues; reports on and recommends solutions. • Accountable for meeting the financial, operational, and quality objectives of the unit. • Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns. • Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation requirements. • Manages to performance measures and standards for quality service and cost effectiveness and coaches the team/individuals to take appropriate action. • Participation in the staff selection process using clearly defined requirements in terms of education, experience, technical and performance skills. • Build strong functional teams through formal training, diverse assignments, coaching, mentoring and other developmental techniques. • Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and individuals. • Ensures work of team meets federal and state requirements and quality measures, with respect to letter content and turn-around time for appeals, complaints and grievances handling. • Holds individuals/team accountable for results; recognize/reward as appropriate. • Lead change efforts while managing transitions within a team. • Identifies trends and emerging issues and reports on and gives input on potential solutions.