Customer Service Representative
Aetna - Phoenix, AZ

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EXTERNAL CANDIDATES: Go toWorkAtAetna.comto apply for this job.DoNOTclick on the "apply to job" button.CURRENT EMPLOYEES: Continue.

POSITION SUMMARY
To increase member satisfaction, retention, and growth by efficiently delivering competitive services to member 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. -Documents and tracks contacts with members, providers and plan sponsors. -Explains members rights and responsibilities in accordance with contract, our Member Handbook and our Provider Manual.-Processes complaints (member/provider), grievance and appeals via internal processes and reporting systems. -Educates providers on our self-service options; Assists providers with questions and assigning members to their panel/practice.-Handles extensive file review requests; Assists in preparation of trend reports, compiling data for audits and other duties assigned. -Verifies member plan eligibility and documents applicable contact/inquiries via our internal applications. -Handles incoming requests/inquiries for appeals and pre-authorizations not handles by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
REQUIRED SKILLS
Service/Providing Solutions to Constituent Needs/FOUNDATION
Service/Handling Service Challenges/ADVANCED
Service/Demonstrating Service Discipline/FOUNDATION
DESIRED SKILLS
General Business/Maximizing Work Practices/ADVANCED
Benefits Management/Interacting with Medical Professionals/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
ADDITIONAL JOB INFORMATION
The shift we are hiring for is Monday through Friday 9:30 pm to 6:00 pm. Candidate must be available to work any shift between the hours of 7:00am to 6:00pm for training and business needs. -Ability to multi-task to accomplish workload efficiently.-Analytical skills-Ability to maintain accuracy and production standards-Technical skills and computer literacy-Intermediate to advanced professional typing skills-Oral and Written communication skills-Understanding or ability to quickly learn medical terminology-Problem solving skills-Attention to detail and accuracy-Bi-lingual preferred

Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
EXTERNAL CANDIDATES: Go toWorkAtAetna.comto apply for this job.DoNOTclick on the "apply to job" button.CURRENT EMPLOYEES: Continue.
Job Function: Customer Service

Aetna - 23 months ago - save job - copy to clipboard
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Aetna is about more than just doing a job. This is our opportunity to re-shape health care for America and across the globe. We are...