Aetna Mercy Maricopa Customer Servic in Phoenix, Arizona

Req ID: 37969BR


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

Fundamental Components:

Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. (*)

Explains member's rights and responsibilities in accordance with contract. (*)

Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management .(*)

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

Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. (*)

Additional Information (situational competencies, skills, work location requirements, etc.)

Ability to multi-task to accomplish workload efficiently.

Analytical skills.

Ability to maintain accuracy and production standards.

Technical skills.

Oral and written communication skills.

Understanding of medical terminology.

Problem solving skills.

Attention to detail and accuracy.

Negotiation skills.


Experience in a production environment.

Customer Service experiences in a transaction based environment such as a call center or like setting in behavioral or medical healthcare.


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 - Member Services - Traditional products/1-3 Years

Functional - Customer Service/Customer service - production environment/1-3 Years


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

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

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User


Benefits Management/Interacting with Medical Professionals/FOUNDATION

Benefits Management/Promoting Health Information Technology/FOUNDATION

Service/Demonstrating Service Discipline/FOUNDATION


Leadership/Driving a Culture of Compliance/FOUNDATION

Leadership/Fostering a Global Perspective/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION


This is an exciting and new opportunity to work with Mercy Maricopa Integrated Care, a non-profit organization administered by Aetna. Mercy Maricopa Integrated Care is looking for caring people who share our vision of recovery and integrated care. Mercy Maricopa Integrated Care is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.

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.

Job Function: Customer Service