Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature. Our mission is to increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.
Answers questions and resolves issues based on phone calls/letters from members and providers. Documents and tracks contacts with members & providers.
Explains member's rights and responsibilities and program benefit coverage details along with verifies member plan eligibility in accordance with contract.
Educates providers on our self-service options;
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management .
Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
1+ year Customer Service experiences in a transaction based environment such as a call center or retail location required.
MS Office Suite experience required
Ability to Multi-Task and meet production goals
Technical, Oral and Written Communication Skills
Understanding of Medical Terminology
Problem Solving Skills
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
ADDITIONAL JOB INFORMATION
Working at Aetna is an opportunity to re-shape healthcare for America and across the globe. We are committed to developing solutions to improve the quality and affordability of healthcare. We care about our members, providers and communities that we serve and each other. We are inspired to make a difference, committed to demonstrating integrity and excellence which is the Aetna Way.
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. N/A