Aetna Integrated Services Specialist in Tucson, Arizona

Req ID: 42629BR

POSITION SUMMARY

Responsible for servicing customers by processing enrollment forms and questions, account receivable inquiries or claims and adjustments in an accurate and timely manner. Develops and enhances customer relationships and assists others to accomplish the same by responding to customer inquiries and resolving customer concerns accurately and quickly. Strives to exceed customer expectations in all contacts with them. Serves as a training resource and mentor.

Fundamental Components:

Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail to respond to inquiries and resolve concerns, including those of a difficult and challenging nature; takes responsibility for following-through and bringing outstanding issues to closure; assists with supervisory calls as necessary. Processes enrollment forms, account receivable inquiries, paper claims and/or electronic work queues accurately and efficiently, including complex HCFA 1500 and UB92 forms; interprets and processes difficult adjustments in accordance with company policies and procedures; reviews basic pending claims to determine the appropriateness of the claim status and takes necessary action based on status. Researches customer inquiries and information by effectively using the "Essentials" on-line resource library and Navigator to gather information needed to process the application or customer request, or to assemble the documentation needed to process claims and adjustments and in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility; quickly assesses and applies information to various customer situations. Investigates, analyzes and resolves outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems for enrollment, accounts receivable or claims payment issues through analysis and evaluation of information and alternate solutions. Anticipates and quickly identifies customer needs; acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making; applies good judgment and logic in evaluating and resolving difficult enrollment, accounts receivable or claims issues. Employs full understanding of all products. Maintains phone and enrollment, accounts receivable or claims quality, and performance levels while working on customer related and other special projects. Serves as a training resource and mentor to others, particularly new hires; shares best practices. Seeks avenues for developing professional expertise and actively pursues new learning opportunities which support the company's goals and objectives. Promotes a positive team environment; acknowledges others' contributions and provides feedback to team members. Performs other related duties as required.

BACKGROUND/EXPERIENCE desired:

Minimum of one year recent and related Contact Center customer service or enrollment, accounts receivable or claims processing experience

Experience with a Windows-based pc environment and in utilizing common office applications, including email, MS Word, Excel, and PowerPoint.

Experience in providing constructive feedback and serving as a training resource, mentor and coach

EDUCATION

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

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.

Job Function: Customer Service