Aetna Eligibility Consultant in New York, New York

Req ID: 42701BR

POSITION SUMMARY

Process accurate and timely referrals into Aetna Systems utilizing Aetna policy guidelines and in accordance with key performance measures.

Fundamental Components:

Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. Develops strong relationship with referral sources and Account Management team.

Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients and marketing staff to achieve positive service outcomes.

Acts as the liaison between clients, vendors, and internal enrollment department to ensure streamlined enrollment process.

Strong understanding of New York MLTC market, able to articulate program to potential members.

Develop strong relationships with external customers and potential members / families navigating them through the enrollment process.

Maintain detailed notes, updates to internal systems, and communicate accordingly to external clients.

Ensures all communications with clients, providers, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.

Exhibits the following Eligibility Cnslt - Electronic Behaviors

BACKGROUND/EXPERIENCE desired:

MLTC (Managed Long Term Care) experience is REQUIRED.

Attention to detail and accuracy.

Problem solving skills.

Strong organization skills.

Understands the impact of work to other teams and downstream support areas.

Ability to analyze and research data to make appropriate corrections as necessary.

Sound understanding of system errors and how to resolve efficiently.

Strong verbal and written communication skills

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

REQUIRED SKILLS

Maximizing Work Practices

Handling Service Challenges

Providing Solutions to Constituent Needs

DESIRED SKILLS

Communicating for Impact

Managing Sales Relationships

Working Across Boundaries

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