Aetna Customer Service Consultant in Vietnam, Vietnam
Req ID: 42100BR
· Handles telephone and written correspondence from varied sources (providers, members, plan sponsors, attorneys and other company personnel). Also reviews claims cost payments in order to respond to all requests for reconsiderations or appeal. · Makes outbound calls if necessary for client follow-up. · Perform a wide variety of customer service related functions, including phone calls, written inquiries, out reach programs, and walk-ins. Explains customer/member specific plan of benefits along with member's responsibilities in accordance with contracted arrangements. · Processes rework claims to minimize customer hand-offs and improves single call resolution. · Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. · Diaries, reviews, and manages all pending claims and claim follow-ups daily focusing on earliest release possible. · Handle complaints (member/provider), grievance and appeals (member/provider) via relevant recording/reporting system. · Ensures compliance with requirements of regional compliance authority/industry regulator. · Responsible for managing complex claim research scenarios and serving as a technical resource to colleagues on claim resolution, triaging of claim pre-authorization issues, and similar situations requiring senior level expertise. · Documents and tracks all member contacts, events, and outcomes via appropriate systems. · Works to enhance provider satisfaction while balancing interests of plan sponsor and member; keeps abreast of all network nuances (disruptions, terminations, additions, unique contract items, etc.). · Accesses information from a variety of systems and references including contracting and network system. · Identifies systemic provider issues and partners with the appropriate parties for resolution. · Adheres to international privacy policies, practices and procedures.
Job Function: Customer Service