Aetna Customer Service Representative (Customer Care Executive) in Farnborough, United States
Req ID: 51475BR
About AetnaAetna International is a leading provider of international expatriate private medical insurance and health management solutions. We have over 1000 staff and growing every day. Our customer base is over 123,000 members located worldwide; and we have more than 71,000 health care professionals and facilities worldwide in the offices in all the major regions of the world.Position SummaryAn exciting opportunity has become available to join our Client Services team as a Customer Care Consultant. We are looking for the right talent to increase member satisfaction, retention, and growth by efficiently delivering competitive services to our Individual, Corporate members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes. Responsibilities of the role · Performs 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.· 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· 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.Experience and Background Required · Previous experience in a customer service environment, preferably in an insurance company, service provider or health insurer – but not essential.· Strong administration skills PC and Database Literate.· Customer-focused communication skills – high level of verbal and written communication.· Organized and able to prioritise and have pride in attention to detail and accuracy. Education· Maths and English grade C or above· University/College degree preferable or equivalent work experience.
Job Function: Customer Service