Aetna Customer Service Representative in Franklin, Tennessee

Req ID: 46352BR

POSITION SUMMARY

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. Responsible for providing telephonic support to members and those acting on members behalf by responding to routine inquiries concerning eligibility information and benefit clarification. Work is performed within a team environment.

FUNDAMENTAL COMPONENTS

-Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

-Answers questions and resolves issues based on phone calls/letters from members, providers, and brokers. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, - providers and brokers.

-Explains member's policy benefits and coordination with Medicare

-Handle complaints (member/provider), via relevant recording/reporting system

-Ensures compliance with requirements of regional compliance authority/Medicare

-Determines applicable coverage provisions and verifies member plan eligibility

-Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data analysis as necessary.

-Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received

-Adheres to international privacy policies, practices and procedures

BACKGROUND/EXPERIENCE

1-3 years of experience in a production environment required.

1-3 years customer service experiences in a transaction based environment such as a call center or retail location preferred.

EDUCATION

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

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: Customer Service