Customer Service Representative

• Handle customer service inquiries and problems via telephone, internet or written correspondence
• Engage, consult and educate members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources
• Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
• Document and track contacts with members, providers and plan sponsors
• Guide the member through their members plan of benefits, Aetna policy and procedures
• Create an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health
• Process claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
• Educate providers on our self-service options
• Assist providers with credentialing and re-credentialing issues
• Respond to requests received from Aetna's Law Document Center regarding litigation
• Handle extensive file review requests
• Assist in preparation of complaint trend reports
• Assist in compiling claim data for customer audits
• Determine medical necessity, applicable coverage provisions and verify member plan eligibility relating to incoming correspondence and internal referrals
• Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
• Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
• Perform financial data maintenance as necessary
• Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received
• Take inbound Brokerage calls to provide application status, contract and appointment status
• Review commission inquires, data entry, processing of Medicare contracts, appointments and verification of certification for external producers/agents to be eligible to market Medicare plans
• Supplement the background check review and documentation process

• Experience in a production environment
• Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate

MS suit experience

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access