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.
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
Ability to maintain accuracy and production standards
Oral and written communication skills
Problem solving skills
Attention to detail & accuracy
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
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