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Aetna Eligibility Consultant - Paper in Newark, Delaware

Req ID: 61973BR

Job Description

DE based position supporting multiple health plans. The Enrollment Representative under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.

Fundamental Components included but are not limited to:

  • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information

  • Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.Monitors daily status reports assessing output for developing trends potentially impacting service levels.

  • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.

  • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.

  • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).

  • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).

  • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities

  • May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

Qualifications Requirements and Preferences:

  • Attention to detail and accuracy

  • Problem solving skills

  • Strong organization skills

  • Understands the impact of work to other teams and downstream support areas.

  • Ability to analyze and research data to make appropriate corrections as necessary.

  • Strong verbal and written communication skills.

Functional Skills:

Claim - Claims Administration - coordination of benefits (COB) verification, Customer Service - Customer Service - Plan Sponsor - Eligibility - HMO, Customer Service - Customer Service - Plan Sponsor - Enrollment - HMO

Required Skills:

General Business - Communicating for Impact, Leadership - Collaborating for Results, Service - Working Across Boundaries

Desired Skills:

Leadership - Driving a Culture of Compliance

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.