Aetna Customer Service Representative in Houston, Texas

Req ID: 43703BR

Candidate must work full time from Houston, TX office, no telework at this time.


Handles Provider Service inquiries and problems via telephone, internet or written correspondence. This would include claims, benefits and eligibility assistance as needed

Fundamental Components:

Answers questions and resolves claim /contract related issues based on phone calls/letters from providers and plan sponsors. Triages resulting rework to appropriate staff.

Documents and tracks contacts.

Assists providers with claim inquiries, benefits and eligibility status

May assist in claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider)

Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.

Assists in handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management

Performs review of claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.

Uses applicable system tools and resources to service the caller with one call resolution in mind


Customer Service experience REQUIRED.

Ability to multi-task to accomplish workload efficiently.

Analytical skills.


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/Customer service - Medical billing/1-3 Years


Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User


Service/Demonstrating Service Discipline/FOUNDATION

Service/Working Across Boundaries/ADVANCED


Service/Creating a Differentiated Service Experience/ADVANCED

Service/Handling Service Challenges/ADVANCED

Service/Providing Solutions to Constituent Needs/FOUNDATION


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