Eligibility Cnslt – Paper

DE based position supporting multiple health plan. The Enrollment Representative under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.

Fundamental Components:

Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. (*) Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI). (*) Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

BACKGROUND/EXPERIENCE desired:

Attention to detail and accuracy. Problem solving skills. Strong organization skills. Understands the impact of work to other teams and downstream support areas. Ability to analyze and research data to make appropriate corrections as necessary. Strong verbal and written communication skills.

EDUCATION

The minimal 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 – Plan Sponsor – Eligibility – HMO/1+ Years

Functional – Claims/Claims Administration – coordination of benefits (COB) verification/1+ Years

Functional – Customer Service/Customer Service – Plan Sponsor – Enrollment – HMO/1+ Years

REQUIRED SKILLS

General Business/Communicating for Impact/ADVANCED

Leadership/Collaborating for Results/FOUNDATION

Service/Working Across Boundaries/ADVANCED

DESIRED SKILLS

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Handling Service Challenges/ADVANCED

Service/Providing Solutions to Constituent Needs/ADVANCED

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.