Aetna Customer Service Representative (Bilingual) in Dallas, Texas

Req ID: 54703BR

POSITION SUMMARY

Handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

Fundamental Components:

  • Answers questions and resolves issues based on phone calls/e-mails from members and providers.

  • Triages resulting requests to appropriate staff. -Documents and tracks contacts with members and providers.

  • Explains member's rights and responsibilities in accordance with contract.

  • Processes complaints (member/provider) and appeals (member/provider) via target system.

  • Educates members on our self-service options.

  • Performs review of member claim history to ensure accurate responses and information is given to the caller.

BACKGROUND/EXPERIENCE desired:

  • Experience in a production environment.

  • Customer Service experiences in a transaction based environment such as a call center preferred, demonstrating ability to be empathetic and compassionate

  • Experience in a high volume Customer Service Call Center environment a plus

  • Ability to speak/read/write Spanish fluently is a plus

  • Knowledge of medical terminology preferred but not required

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Customer Service/Call center monitoring & analysis - Inbound calls - call center location/

Functional - Customer Service/Customer Service - Member Services - HMO products/

Functional - Customer Service/Customer Service - Member Services - Traditional products/

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/FOUNDATION

Service/Demonstrating Service Discipline/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION

DESIRED SKILLS

Service/Creating a Differentiated Service Experience/ADVANCED

Service/Handling Service Challenges/ADVANCED

Leadership/Fostering a Global Perspective/FOUNDATION

ADDITIONAL JOB INFORMATION

Ability to multi-task to accomplish workload efficiently. Analytical skills. Ability to maintain accuracy and production standards. Technical/ Computer skills. Oral and written communication skills. Problem solving skills. Attention to detail and accuracy. Negotiation 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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.