Job Responsibilities: Customer Service Representative
Salary: $20-30/Hour
Company: Aetna
Location: Frankfort, USA
Educational Requirements: Bachelor's Degree
Process Description
We are currently recruiting top skills for our center of Excellence customer service group.
- Customer support representative is the face of Aetna and impacts members’ carrier revel in by way of way of ways customer support inquiries and problems thru phone, internet or written correspondence are dealt with. -consumer inquiries are of simple and at instances complicated nature.
- Engages, consults and educates members based upon the member’s particular wishes, choices and information of Aetna plans, gear and sources to help guide the members alongside a clean route to care.
- Answers questions and resolves problems primarily based on smartphone calls/letters from members, vendors, and plan sponsors. Triages ensuing rework to suitable staff.
- Files and tracks contacts with contributors, companies and plan sponsors. The CSR courses the member via their members plan of blessings, Aetna policy and tactics as well as having knowledge of resources to comply with any regulatory recommendations.
- Creates an emotional reference to our individuals through understanding and attractive the member to the fullest to champion for our individuals’ high-quality health.
- Taking accountability to completely understand the member’s needs via constructing a trusting and worrying relationship with the member. Anticipates patron needs.
- Presents the patron with associated records to reply the unasked questions, e.G. Extra plan information, benefit plan information, member self-provider tools, etc.
- Uses customer support threshold framework to make economic choices to solve member issues.
- Explains member’s rights and responsibilities according with settlement.
- Approaches declare referrals, new claim handoffs, nurse critiques, court cases (member/company), grievance and appeals (member/issuer) through goal gadget.
- Educates carriers on our self-carrier options; Assists carriers with credentialing and re-credentialing issues.
- Responds to requests obtained from Aetna’s regulation record middle regarding litigation; complaints.
- Handles extensive record overview requests.
- Assists in education of complaint fashion reports.
- Assists in compiling claim statistics for customer audits.
- Determines scientific necessity, applicable coverage provisions and verifies member plan eligibility referring to incoming correspondence and internal referrals.
- Handles incoming requests for appeals and pre-authorizations no longer dealt with via scientific declare management.
- Plays evaluation of member claim history to make certain correct monitoring of benefit maximums and/or coinsurance/deductible.
- Plays economic facts protection as important. Makes use of relevant machine gear and sources to provide first-class letters and spreadsheets in response to inquiries acquired.
Required qualifications
- Customer service experiences in a transaction based surroundings which include a name center vicinity preferred, demonstrating ability to be empathetic and compassionate.
- Revel in in a production environment.
- Prior revel in offering customer support to the senior population, understanding of clinical terminology inclusive of medicare and medicaid regulations
Desired Qualifications
- Please review the required qualifications above
Training
- High college degree, G.E.D. Or equivalent revel in
Enterprise Overview
Bring your coronary heart to CVS fitness each one people at CVS fitness stocks a unmarried, clean motive: Bringing our coronary heart to every second of your health. This motive courses our commitment to deliver stronger human-centric health care for a hastily converting global. Anchored in our emblem — with heart at its middle — our reason sends a private message that how we deliver our services is just as crucial as what we deliver. Our heart At work Behaviors™ guide this motive. We want everybody who works at CVS fitness to experience empowered by means of the position they play in remodeling our lifestyle and accelerating our potential to innovate and supply answers to make health care extra personal, convenient and less expensive. We strive to sell and sustain a culture of range, inclusion and belonging each day. CVS fitness is an affirmative action enterprise, and is an same possibility company, as are the health practitioner-owned groups for which CVS health gives control offerings. We do now not discriminate in recruiting, hiring, advertising, or every other employees motion based on race, ethnicity, coloration, national origin, intercourse/gender, sexual orientation, gender identification or expression, faith, age, incapacity, covered veteran repute, or another characteristic included by using relevant federal, state, or local regulation. We proudly assist and inspire human beings with army experience (lively, veterans, reservists and country wide defend) as well as military spouses to apply for CVS health process opportunities.
