Customer Support

• Engage, consult, and educate members, based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources, in order to guide the members along a clear path to care.
• Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors.
• Triage resulting rework to appropriate staff.
• Document and track contacts with members, providers, and plan sponsors.
• Guide members through benefits plan and Aetna policy & procedures, while maintaining knowledge of resources to comply with any regulatory guidelines.
• Take accountability to fully understand members’ needs by building a trusting and caring relationship with them.
• Anticipate customer needs.
• Provide the customer with related information to answer various questions; e.g. additional plan details, benefit plan details, member self-service tools, etc.
• Use customer service threshold framework to make financial decisions to resolve member issues.
• Explain members’ rights and responsibilities in accordance with contract.
• Handle incoming requests for appeals and pre-authorizations, specifically those not handled by Clinical Claim Management.
• Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.

Customer Service Representative

Salary

Job Level

About the role

Requirements

Retention Specialist, Spanish Speaker

Associate Clinical Director

Customer Advocate

Accounts Receivable Representative II

Patient Account Representative - Remote