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Aetna Network Relations Specialist in San Diego, California

Req ID: 63563BR

Job Description

Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, plan design, credentialing process or status, and claims or compensation process or status. Supports the maintenance of contract, provider demographic data and education.

Fundamental Components included but are not limited to:

  • Triages routine provider issues and internal inquiries regarding policies and procedures, credentialing or claims status, orientation activities, and database or portal information or usage.

  • Escalates issues as appropriate.

  • Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.

  • Performs credentialing support activities as needed.

  • Educates providers on portals, protocols, policies, procedures, and services to enhance the overall provider experience.

  • May assist with or perform standard provider recruitment or contracting or re-contracting functions and discussions.

Qualifications Requirements and Preferences:

  • Strong verbal and written communication and interpersonal skills.

  • Exposure to business segment specific policy, benefits, plan and product design and language.

  • Working knowledge of Medi-Cal business segment specific codes, products, and terminology.

  • 1-3 years' related customer service experience preferrably with exposure to benefits interpretation.

  • Associate's degree or equivalent work experience.

Functional Skills:

Communication - Communication Delivery - Public Speaking, Customer Service - FE Customer Service - Provider - HMO, Network Management - Provider relations

Required Skills:

General Business - Ensuring Project Discipline, Service - Creating a Differentiated Service Experience, Service - Handling Service Challenges

Desired Skills:

General Business - Applying Reasoned Judgment, General Business - Turning Data into Information, Service - Working Across Boundaries

Benefit Eligibility

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

Job Function: Healthcare

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.