Aetna AetnaOne Member Advocate in New Albany, Ohio
Req ID: 42597BR
The Health Services Advocate is a part of a dedicated team of advocates empowered to provide a suite of clinical and administrative services to our members. Health Services Advocates are empathetic and accountable individuals responsible for providing end-to-end member support. As the single point-of-contact this role will build trust with members, demonstrate ownership for the resolution of issues, and act with fast knowledge using integrated service tools. This role will drive the development of a deep understanding of individual members needs through differentiated methods of defining a members health ambitions, the use of predictive analytics to build a 360 view of the member, and by providing continuous, omni-channel support in line with member preferences. Health Services Advocates will engage members through personalized, effective and frequent touchpoints to deliver a simple, powerful, and proactive member experience
Acts as a single-point-of-contact for the member. Explains member plan of benefits, members rights & responsibilities in accordance with contracts & contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.
Deliver a suite of administrative services to members that support easy navigation of the healthcare system, from providing personalized next best action recommendations, to maintaining individual data accuracy and integrity
Create an emotional connection with our members by understanding & engaging them to the fullest
Assists the member in finding their health ambition
Connects the member with additional administrative & clinical resources as necessary
Uses proactive, predictive and preventative analytics to service the member & conduct outreach/provide omni-channel inbound & outbound inquiry support
Provides high-quality, customer-focused telephonic service using knowledge of procedures and systems to meet &/or exceed customer satisfaction while educating constituents on Aetnas policies & programs
Coordinates with clinicians to compile the member's Care Plan & conduct adherence follow-up
Works with case managers for members who require urgent or emergent service, or services rendered in a setting other than a practitioners office. Serves as subject matter expert for team members for non-routine calls that required deviation from standard scripts
End to End accountability for the member
Handle sensitive member information with discretion
Prioritizes effectively to meet member service goals / deadlines
Resolves issues without or with limited management intervention
Showcases a passion about health
Deep problem solving skills, demonstrates ownership of issue resolution - accountability
Demonstrates the ability to build a trusting relationship with members by fully understanding the members needs from beginning to end
Demonstrates a passion for health and customer service that drives proactive engagement with members in support of a personalized plan to meet their health ambitions
Lends Subject Matter Expertise to team members & acts as resource for day to day processes, provides direction on routine & difficult issues
Collaborates with colleagues to deliver a world class customer experience
5+ years experience working directly with consumers delivering a highly experiential interaction preferably in a leading retail setting, hotel/concierge, non-profit, financial services, travel agency, real estate or other customer-sponsor oriented role
High School Diploma or G.E.D
Associates Degree or equivalent work experience
Demonstrated ability to uphold Aetnas values
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
Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment
Demonstrated organizational and communication skills required
Possess top-notch people skills listening, caring, connecting, showing empathy, and supporting
Highly perceptive individual with strong self-awareness and empathy in interacting at various levels with different audiences
Ability to make effective and independent decisions
Demonstrates responsiveness and a sense of urgency when dealing with customers
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