Aetna Plan Builder in Amherst, New York

Req ID: 44318BR

POSITION SUMMARY

Provides plan benefit review, interpretation and systematic setup essential for online viewing and processing related to Customer Service, Claims, Enrollment, Billing and Reporting in support of internal and external partners.

Fundamental Components:

Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients.

Uses business knowledge and experience to make plan design and pricing recommendations when working with prospective customers.

Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy clients needs while minimizing impact on Meritains system and operations; Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity.

Collaborates on review, analysis and development of recommendations for the design of complex account and benefit structures based on customers objectives and Meritains system.

Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.)

Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)

BACKGROUND/EXPERIENCE:

Healthcare industry experience (Customer Service and/or Claims) is required

Plan Build experience is preferred

Detail oriented

Highly organized

Good communication skills

EDUCATION

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

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/PC Anywhere//End User

Technical - Mainframe Tools and Software///End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Service/Improving constituent-focused Processes/FOUNDATION

DESIRED SKILLS

General Business/Demonstrating Business and Industry Acumen/FOUNDATION

General Business/Maximizing Work Practices/ADVANCED

General Business/Communicating for Impact/ADVANCED

Telework Specifications:

Would consider applicants in any of the Meritain Office locations

ADDITIONAL JOB INFORMATION

The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits.

This person should be highly organized and able to quickly prioritize multiple assignments with high quality results.

This person should have good communication skills with the ability to express complex concepts in a clear and concise manner.

This person should have a high attention to detail and accuracy while focusing on overall project deliverables.

This person should have the ability to remain flexible yet focused during stressful situations.

This person should possess good analytical and problem solving skills.

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.

Job Function: Customer Service