Senior Technical Customer Care Specialist – Xtime
Cox Enterprises
ApacheCloud
Customer Service Representative
CVS Health
full-time
Posted on:
Location: Arizona, California, Illinois • 🇺🇸 United States
Visit company websiteSalary
💰 $17 - $31 per hour
Job Level
Junior
About the role
- Acts as the face of Aetna handling customer service inquiries via telephone, internet or written correspondence
- Engages, consults and educates members based on their needs, preferences and understanding of Aetna plans, tools and resources
- Answers questions and resolves issues from members, providers, and plan sponsors
- Triages resulting rework to appropriate staff and documents/tracks contacts
- Guides members through plan benefits, Aetna policy and procedures, and regulatory resources
- Processes claim referrals, new claim handoffs, nurse reviews, complaints, grievance and appeals via target system
- Educates providers on self-service options and assists with credentialing/re-credentialing issues
- Responds to Aetna's Law Document Center requests regarding litigation and handles extensive file reviews
- Assists in preparation of complaint trend reports and compiles claim data for customer audits
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility
- Performs review of member claim history and financial data maintenance as necessary
- Uses system tools to produce quality letters and spreadsheets in response to inquiries
Requirements
- 1 year of Customer service experience
- Ability to multi-task to accomplish workload efficiently
- Oral and written communication skills
- Ability to maintain accuracy and production standards
- Technical skills
- Problem solving skills
- Attention to detail and accuracy
- Preferred: 1 year of healthcare experience
- Preferred: 1 year of call center experience
- Preferred: Reside in IL
- Education: High School or GED equivalent
