Aetna Eligibility Consultant in Phoenix, Arizona
Req ID: 59997BR
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:
Medicaid experience a plus
Administration / Operation - Data Entry, Claim - Claims Administration - coordination of benefits (COB) verification, Customer Service - Customer Service - Plan Sponsor - Enrollment - Traditional
Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel
Additional Job Information:
Ability to analyze and research data to make appropriate corrections as necessary.
Understands the impact of work to other teams and downstream support areas.
Strong verbal and written communication skills.
Strong organization skills.
Problem solving skills.
Attention to detail and accuracy.
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.