Aetna Customer Service Representative in Phoenix, Arizona
Req ID: 45728BR
To increase member satisfaction, retention, and growth by efficiently delivering competitive services to member and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
-Documents and tracks contacts with members, providers and plan sponsors.
-Explains members rights and responsibilities in accordance with contract, our Member Handbook and our Provider Manual.
-Processes complaints (member/provider), grievance and appeals via internal processes and reporting systems.
-Educates providers on our self-service options; Assists providers with questions and assigning members to their panel/practice.
-Handles extensive file review requests; Assists in preparation of trend reports, compiling data for audits and other duties assigned.
-Verifies member plan eligibility and documents applicable contact/inquiries via our internal applications.
-Handles incoming requests/inquiries for appeals and pre-authorizations not handles by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Is vigilant in identifying possible compliance/ethics issues and reports any concerns to manager/supervisor, Medicaid Compliance Officer, internal legal counsel or Alert Line. Is truthful and ethical in all work performed.
Experience in a production environment.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred.
The minimum 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 - Member Services - Traditional products/1+ Years
Functional - Customer Service/Customer service - production environment/1+ Years
Service/Demonstrating Service Discipline/FOUNDATION
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/FOUNDATION
Benefits Management/Interacting with Medical Professionals/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
ADDITIONAL JOB INFORMATION
The shift we are hiring for is Monday through Friday 9:30 pm to 6:00 pm. Candidate must be available to work any shift between the hours of 7:00am to 6:00pm for training and business needs.
-Ability to multi-task to accomplish workload efficiently.
-Ability to maintain accuracy and production standards
-Technical skills and computer literacy
-Intermediate to advanced professional typing skills
-Oral and Written communication skills
-Understanding or ability to quickly learn medical terminology
-Problem solving skills
-Attention to detail and accuracy
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