Aetna Network Relations Specialist - FL MCD in Sunrise, Florida

Req ID: 53422BR

POSITION SUMMARY

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 or demographic data.

Fundamental Components:

  • 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.

BACKGROUND/EXPERIENCE desired:

  • Background/Experience Desired: 1-3 years' related customer service experience preferably with exposure to benefits interpretation.

  • Bilingual skills a plus.

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

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

  • Computer literate and proficiency with strong keyboard navigation skills; proficiency with MS Office Suite applications: Outlook, Excel and Word.

  • Strong verbal and written communication and interpersonal skills.

  • Organizational and time management skills.

  • Education and Certification Requirements: Associate's degree or equivalent work experience.

EDUCATION

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

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 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: Health Care