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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Field Services Advocate is empowered to serve as a bridge between an Aetna National Accounts client’s members, the customer Benefit Service Center, HR colleagues and Total Rewards Team to promote available health and wellness programs, tools, and resources, including those offered by Aetna as well as the client’s other vendors. This can include providing both administrative and clinical support to members as well as navigating them through the health system, providing support on claims issues, and answering coverage-level questions. The Field Services Advocate is an empathetic and accountable individual responsible for providing end-to-end support to the customer’s members through an ‘Apple Store genius bar’-like experience. As a single point-of-contact, this person builds trust with members, demonstrates ownership for the resolution of issues, and acts with fast knowledge using integrated service tools. This person develops a deep understanding of individual members’ needs by determining a members health ambition, using predictive analytics to build a 360˚ view of the member, and by providing multi-channel support in line with member preferences. Field Services Advocates engage members through personalized, effective, and frequent touchpoints to deliver a simple, powerful, and initiative-taking experience.
Job Responsibility:
Function as primary contact for day-to-day escalations of benefit-related issues brought forward by the customer’s Human Resources (HR) representatives, Total Rewards Team or by members themselves. Provide excellent customer service and a positive member experience to all inquirers
Work with members, HR representatives and the Total Rewards Team to help them understand their benefits and connect them to available resources
Assist members in identifying modifiable risk factors by referring to and leveraging the resources provided by the customer on lifestyle change, including weight management, quitting tobacco, stress reduction, nutrition and increasing physical activity
Recommend, create, and deliver content for health education newsletters, new hire orientation, Annual Enrollment, and other communication initiatives in line with the customer’s Value Proposition
Plan and execute health awareness tables and other onsite events requested by the Total Rewards team
Be accountable for resolving any benefits related issues including answering routine questions, addressing denied claims, preauthorization, and providing support to both the employees and the customer Total Rewards team on appeals
Assist the Total Rewards team with the administration of the customer Wellness program and other programs as needed
Acts as a single-point-of-contact for the member and the customer’s HR and Benefits teams. Explains benefits, rights, and responsibilities in accordance with contracts and contracted arrangements, claim status information, plan coverage, plan eligibility, medical, dental, vision, pharmacy, spending and savings accounts, tool usage, and available programs and resources such as care management
Creates an emotional connection with members by understanding and engaging them to the fullest
Assists members in finding their health ambition
Guides members’ use of digital and clinical resources, including CVS Health Hubs and other community resources
Provides high-quality, customer-focused engagement using knowledge of procedures and systems to meet and/or exceed customer satisfaction while educating members on Aetna’s policies and programs
When required, coordinates the member's Care Plan, and conducts adherence follow-up
Works with Aetna’s care team for members who require urgent or emergent service, or services rendered in a setting other than a practitioner’s office
Serves as subject matter expert for non-routine calls that require deviation from standard responses
Handles sensitive member information with discretion
Resolves issues with no or limited management intervention
Responsible for all levels of member engagement
Coordinates and/or delivers health education, program seminars, workshops, and webinars within Aetna and the customer
Attends and participates in meetings with the customer and Aetna Account teams as requested including training and information sharing
Partners with Data Analytics team to determine opportunities for targeted engagement and focused program utilization to positively impact future benefits spend, including preparing dashboards, reporting to the customer Total Rewards team, and measuring success through improved member health as evidenced through Data Analytics
Assists the customer’s Wellness Representative(s) in managing all aspects of the wellness program, including but not limited to coordinating health fairs, assisting with employee communications, serving as an advocate for the program and the wellness champions at each location. Would also include keeping a current roster of wellness champions and recruiting for locations when/where there is a need
Requirements:
5+ years’ experience working directly with consumers delivering a highly experiential interaction
Experience with Aetna and CVS products, claim systems, and digital member applications
Associate degree or equivalent work experience
Appropriate education relevant to clinical background
Knowledge of benefit rules, regulations, policies, and procedures including federal, state, and local regulations related to benefits, including COBRA, ERISA, HIPAA, and Section 125
Demonstrated ability to uphold the customer’s and Aetna’s values of caring, inspiration, integrity, and excellence in each member interaction
Outstanding organizational ability including keen attention to detail, strong follow-up skills
deadline-oriented and demonstrated ability to prioritize and multi-task in a fast-paced changing environment
Organizational and communication skills necessary
Competency with MS Office products - Word, PowerPoint, Excel
Nice to have:
Showcases a passion about health, benefits, and member experience
Deep problem-solving skills, demonstrates ownership of issue resolution - accountability
Demonstrates the ability to build a trusting relationship with members by fully understanding their needs from beginning to end
Lends Subject Matter Expertise to the customer’s Total Rewards team and acts as a resource for day-to-day processes and provides direction on routine and difficult issues
Collaborates with colleagues and co-workers to deliver a world class customer experience
Possesses top-notch people skills – actively listens, cares, connects, shows empathy, and is supportive
Highly perceptive individual with strong self-awareness and empathy in interacting at various levels with different audiences
Ability to make independent decisions
Demonstrates responsiveness and a sense of urgency when dealing with members
Utilizes influencing and motivational skills to ensure maximum member engagement to promote lifestyle and behavior changes to achieve optimum level of health
Competency in public speaking and interpersonal engagement with members
Willingness to support members in the Eastern time zone
What we offer:
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