Aetna Senior Customer Service Consltant in Farnborough, United States

Req ID: 48783BR

Family Summary/MissionTo increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processesPosition Summary/MissionWorking shifts on a 4 nights on /4 nights off rotating basis, you will take responsibility for looking after our members across the globe. As a Senior Case Management Associate you will act with a high level of authority, deputizing in the absence of the Service Delivery Leader and undertaking a supervisory role within your team. This position demands a high level of responsibility; you will be expected to act with autonomy, demonstrating the highest professional standards in a challenging yet highly rewarding environment. You will provide operational and logistical support to our Clinical Case Managers, working in partnership to coordinate the delivery of medical evacuation and healthcare services. You will rapidly investigate, review and adjudicate claims, taking a proactive, highly professional and customer centered approachFundamental Components & Physical Requirements include but are not limited to

(* denotes essential functions)• Working within the Member Assistance 24x7x365 contact center, investigate, consider and pre-authorize healthcare claims globally.• Professionally manage inbound and outbound telephone, fax and email correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is maintained.• Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery.• Triage and prioritise caseload considering urgency, geographical location, service required, and customer expectations.• Deputize for the Service Delivery Leader in terms of staff supervision, work allocation, case escalation, complaint management and service recovery.• Take ownership for progression of own caseload and supervise the progress of team members cases providing clear advice and direction to remove barriers and delays.• Coordinate outpatient care, inpatient hospital admissions and emergency evacuations.• Identify, control and escalate high cost claims.• Investigate claims for possible abuse and fraud.• Deliver training and desk side coaching to team members• Escalate unresolved claims, complaints and high costs claims to Service Delivery Leader for guidance.• Continually work to improve best practices, procedures and standards.• Ensure compliance with requirements of regional compliance authority/industry regulator.• Adheres to international privacy policies, practices and procedures.• Strives to deliver consistently excellent customer service internally and externally.• Exhibits the following Employee BehaviorsPerformance MeasuresBackground/Experience Desired• Related supervisory experience preferred.• Previous experience in a Clinical or Medical Assistance Environment highly desirable.• Clinical background a plus.• Proven customer experience in a contact center environment.• Healthcare insurance industry experience.Education and Certification Requirements• Educated to minimum A-Level standard (or equivalent level of experience)• Second language and/or previous clinical qualification / experienceAdditional Information (situational competencies, skills, work location requirements, etc.)• Good knowledge of Microsoft packages.• Competent typist.• Excellent customer service skills with a strong command of written and spoken English.• Good communication skills with strong organizational and problem solving skills.• These roles are working shifts which operate between 19:30 – 07:30 on a 4 nights on / 4 nights off rotating shift basis.• Our team operates 24hrs a day, 7 days a week, 365 days a year and therefore candidates should be prepared to work some bank holidays according to the shift rotation (appropriate compensation is provided)

Job Function: Customer Service