Aetna Sr Eligibility Consultant in Sunrise, Florida

Req ID: 43538BR


Coordinates electronic transfer of eligibility data and maintain enrollment databases Aetna International. Customer facing interactions with clients and vendors demanding high levels of responsiveness. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.

Fundamental Components:

Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. Must possess the ability to work well in a team environment with a drive for individual success and a focus on overall team success. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues


Mentoring and leadership support experience for Senior level Eligibility Consultant, prior/current electronic eligibility file handling. Professionalism to interact with clients, vendors and business partners as a representative of the Electronic Enrollment Department. Responsiveness to inquiries within established service level agreements. Demonstrated technical and analytical skill.


The minimum level of education desired for candidates in this position is high school or equivalent experience. Some college preferred.


Functional - Customer Service/Customer Service - Plan Sponsor - Eligibility - Traditional/1+ Years

Functional - Customer Service/Customer Service - Plan Sponsor - Enrollment - Traditional/1+ Years

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

Functional - Project Management/Issue identification and analysis/1+ Years


Technical - EDI/EDI/1+ Years/

Technical - Desktop Tools/Microsoft Outlook/1+ Years/

Technical - Aetna Applications/EZConnect / Aetna Data Transfer/1+ Years/


Leadership/Collaborating for Results/MASTERY

Service/Handling Service Challenges/MASTERY

Technology/Leveraging Technology/ADVANCED


General Business/Communicating for Impact/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Leadership/Fostering a Global Perspective/FOUNDATION


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