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Site of Care Specialist is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles site of care transitions based on medical policy via telephone, internet, web-chat or written correspondence. Calls are typically non-routine and may require deviation from standard screens, scripts and procedures to engage, consult, and educate members and providers by delivering individualized programs based upon the member's unique needs and preferences.
Job Responsibility:
Provide targeted, personalized service based on a holistic view of the member, benefits, health information
Handle site of care transitions based on medical policy via telephone, internet, web-chat or written correspondence
Engage, consult, and educate members and providers by delivering individualized programs based upon the member's unique needs and preferences
Utilize resources to assist members in understanding components of the Aetna products including claims, accumulators, usage and balances and cost sharing
Provide support to the Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making
Maintain compliance with ERISA, and client specific requirements
Work as part of the team to meet business unit objectives
Requirements:
Ability to deal with a diverse customer base in a friendly and confident manner including medical office providers and members
Must display empathy and effective listening skills to deliver successful cost-saving transitions of care
A proven background in medical/pharmacy benefits, particularly as these relate to infused specialty medications
Strong analytical and critical thinking skills, coupled with the ability to master complex systems
Familiar with computer systems and Microsoft Office skills
Ability to prioritize and manage multiple tasks
Excellent organization skills
Strong detail orientation
Strong verbal and written communication skills
Works well as a member of a team
Strong interpersonal skills
Ability to maintain confidentiality
Knowledge of Aetna systems and processes including ATV, ACAS, NLX, SFDC and others
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