Customer Service Rep

Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

Fundamental Components:

Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. (*)

Explains member’s rights and responsibilities in accordance with contract. (*)

Processes complaints (member/provider), grievance and appeals (member/provider) via target system. (*)

Educates providers on our self-service options;

Determines, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and

Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management .(*)

Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. (*)

BACKGROUND/EXPERIENCE desired:


Experience in a production environment is required

Customer Service experiences in a transaction based environment such as a call center or retail location preferred.

Candidates must be comfortable working a shift that falls between the hours of 10:30AM – 7:00PM Eastern Time

EDUCATION


The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional – Customer Service/Customer service – production environment/1+ Years

Telework Specifications:

Immediate telework can be considered for a candidate in a current Aetna Medicaid Plan. All non-Aetna Medicaid member services and external employees can be considered for telework after an in-office probationary period.

ADDITIONAL JOB INFORMATION


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate’s data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.