Aetna Sr Integrated Svcs Spec in New York, New York

Req ID: 57143BR


Responsible for servicing customers by processing enrollment forms and questions, accounts receivable inquiries, or claims and adjustments. Develops and enhances customer relationships by routinely resolving customer inquiries and concerns and striving to exceed customer expectations in all contacts with them. Assists other team members with developing and enhancing customer relationships. Serves as a training resource, mentor, subject matter expert, and coach.

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; tactfully handles supervisory calls and difficult customer interactions.

Processes routine to complex claims for all physician, facility and specialty areas, including those requiring difficult manual adjudications, stop loss claims, high dollar claims and adjustments, in accordance with company policies and procedures.

Researches and updates customer information by effectively using the "Essentials" on-line resource library and Navigator to resolve enrollment and accounts receivable questions and to process claims and adjustments in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility; creates, updates and monitors enrollment, accounts receivable, customer service and claims payment training information; 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 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; assists other team members; takes ownership for problem resolution.

Performs peer audits including phone quality reviews through the Witness program and claims quality reviews.

Tests new benefit plans, contracts, rule banks and operational enhancements.

Monitors and reviews team operational reports including ACD MAX and Navigator phone reports; effectively uses the tools to drive process improvements and enhance results; assists with phone scheduling

Manages work distribution including paper enrollments, claims, correspondence and work queues; monitors and adjusts workflow accordingly for load balance purposes; employs expert knowledge of all products.


  • Minimum of three years recent and related Contact Center enrollment, accounts receivable or customer service and claims processing equivalent 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


The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.


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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.