Customer Service


General Information
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Job Description To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

Fundamental Components:
Answers questions and resolves issues based on phone calls/letters from providers Triages resulting rework to appropriate staff Documents and tracks contacts with providers Explains providers and/or members rights and responsibilities in accordance with contract Educates providers on our self-service options Assists providers with credentialing and re-credentialing issues Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence or internal referrals Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible Performs financial data maintenance as necessary Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. Maintains department established performance metrics at a meets or exceeds expectations level Works together as a team and apply the Aetna Core Values in day-to-day operations.

Customer Service experience such as retail location or restaurant required.
Ability to multi-task to accomplish workload efficiently
Analytical skills
Ability to maintain accuracy and production standards
Technical skills
Oral and written communication skills
Problem solving skills
Attention to detail & accuracy

Job Requirements
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.