Aetna Customer Service Consultant, MAT Team in Singapore, Singapore

Req ID: 38317BR


2 Openings Family Summary/Mission: Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Position Summary/Mission: Provide operational and logistical support to Clinical Case Managers, working in partnership to coordinate the delivery of pre-authorization services. Rapidly investigate, review and adjudicate claims in advance of treatment taking place. Fundamental Components & Physical Requirements: Working within the Member Assistance contact center, investigate, consider and pre-authorize treatment globally. Professionally manage inbound and outbound telephone, fax and email correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is maintained at all times. Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery. Triage and prioritize caseload considering urgency, geographical location and service level. Take ownership for progression of own caseload, maintain communication, remove barriers, avoid delays. Follow appropriate escalation process for high dollar claims. Investigate claims for possible abuse and fraud. May facilitate training and coaching when considered topic subject matter expert.Escalate unresolved claims complaints and high costs claims to Service Delivery Leader for guidance.Continually work to improve best practices procedures and standards.Ensure compliance with requirements of regional compliance authority/industry regulator.Adheres to international privacy policies, practices and procedures.Strives to deliver consistently excellent customer service internally and externally. Background/Experience Desired: Previous experience in a Clinical or Medical Assistance Environment highly desirableProven telephone customer service experienceHighly beneficial to have worked in an insurance environment Educational Requirements:Clinical qualification would be high beneficial but not essentialFluent in English language communication skills Additional Information:· Working knowledge of Word, Excel, Email and InternetCompetent typist Excellent customer service skills with a strong command of written and spoken English. Good communicator with strong organizational and problem solving skills. · For Singapore location – currently on standard working hours. Subject to change per business needs to a 24/7/365 operation. Should hours change, a generous shift differential will be paid.

Job Function: Customer Service