Aetna Community Engagement Coordinator in Louisville, Kentucky
Req ID: 50693BR
This position is responsible for outbound calls to members for community engagement identification and education. Coordinators will also be responsible for assisting with health plan waiver education and updates to the health plans key community stakeholder partners.
Build community relationships with both internal and external members/constituents. Function as a primary contact for member advocacy groups; work with these groups to identify and correct member access barriers in the community. Coordinate with schools, community and state agencies providing services to members
Answer questions and resolve issues as a "single-point-of-contact" based on phone calls, letters, email, internet, chat, outreach programs. Take ownership of each member contact to resolve their issues and connect them with additional services as needed.
Make outbound calls to members regarding plan payments.
Work closely with Provider Relations staff on provider issues affecting member relationships.
Explain member plan benefits, members rights and responsibilities in accordance with contracts and contracted arrangements, claim status information, full range of benefit coverage, plan eligibility, premium payment and billing.
Investigate and resolve access and cultural sensitivity issues identified by the health plan staff, State staff, providers, advocate organizations, and members.
Organize and provide training and educational materials for the health plans staff and providers to enhance their understanding of the values and practices of all cultures with which the health plan interact be a Cultural Advocate.
Monitor the health plans formal and informal grievances, including premium billing appeals and state incentive reduction appeals, with the grievance personnel to look at trends or major areas of concern. Identify complaint trends and any emerging member service issues and works to develop solutions to address potential problems.
Assist with research and participate or lead special projects/initiatives addressing service issues and support of staff to improve HEDIS measures through community programs and benefit education.
Effective telephone, oral and written communication customer service skills
Bilingual Skills in English/Spanish is preferred
Proficient Microsoft Office Suite skills
Experience in a production environment.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
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//1-3 Years
Service/Creating a Differentiated Service Experience/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED
Option for telework will be evaluated after a certain period of employment
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.
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