Aetna Client Services Representative (ACA fronted employment) - 49775BR in Jakarta, Indonesia

Req ID: 49775BR

Summary/Mission

To 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 processes.

Position Summary/Mission

Handles customer service inquiries and problems via telephone, internet or written correspondence

Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)

• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.

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

• Processes referrals to the Claim and IHAT teams for claim referrals, new claim handoffs, pre-certifications and clinical reviews.

• Handle complaints (member/provider), grievance and appeals (member/provider) via relevant recording/reporting system (new system to be introduced 2010).

• Responds to requests received from Law Document Center regarding litigation/lawsuits.

• Ensures compliance with requirements of regional compliance authority/industry regulator.

• Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

• Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/ deductible. Performs financial data maintenance as necessary.

• Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

• May provide lists of in-network providers and facilities upon request.

• Adheres to international privacy policies, practices and procedures.

• Exhibits the following Employee Behaviors

Background/Experience Desired

• Experience in a production environment.

• Customer Service experiences in a transaction based environment such as a call center or retail location preferred.

• Experience in the Insurance or Financial Services industry desirable.

Education

High School graduate or local market equivalent.

Additional Information (situational competencies, skills, work location requirements, etc.)

• Analytical skills.

• Ability to maintain accuracy and production standards.

• Technical skills.

• Oral and written communication skills.

• Understanding of medical terminology.

• Problem solving skills.

• Attention to detail and accuracy.

• Negotiation skills.

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Job Function: Customer Service