Aetna Eligibility Consultant -Electronic in Sandy, Utah
Req ID: 51901BR
Handles end-to-end processes associated with enrollment management. Identifies and addresses issues impacting the delivery of accurate and timely enrollment into the enrollment system. Responsible for ensuring accurate eligibility data is in the administration systems for claim payment purposes and product production (e.g., ID cards, billings, mailings, etc.). Ensures services and products meet the plan sponsors needs.
Applies technical knowledge of system interfaces and detailed eligibility rules and regulations to ensure eligibility transactions successfully interface to various complex downstream systems based on an understanding of each system's processing rules and interface limitations. Review enrollment forms, listings, or electronic file specifications to assess customer and vendor ability to adhere to Aetna, Inc. standards. Works independently to prioritize workload to accomplish assigned cases. Leads and set up calls with designated internal and external customers to provide status and updates of enrollment. Take proactive approach to ensure enrollment is in the core system successfully. As applicable, provide detailed overview of Aetna's various consumer driven web-based online enrollment portals.
Leads specification walkthrough discussion, identifying and explaining each required field; obtains details around customer/vendors programming abilities and explains front-end programming options (both custom and generic), determines need for generic front end programming based on customers ability to send effective dates and member records, explains generic front end processes regarding effective date processing, MEA and ELR impact, advantages and disadvantages. Attend customer meetings to walkthrough specifications and requirement and provide overall guidance on the implementation. Provide technical guidance a on variety of enrollment files (EDI 834, Aetna standard CEF, Aetna standard 2K, etc.). Creates account structure coding supplement, using CCI export and coding supplement tool.
Responds to eligibility and other enrollment related issues involving member specific information; partners directly with clients, vendors, field marketing staff, and/or local claim operation to resolve problems and achieve positive outcomes aligned with our Common Purpose.
Delivers consulting services in support of data discrepancies and/or involving reporting alternatives. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
With guidance from senior team member, leads specification walkthrough discussion, identifying and explaining each required field, Obtains details around customer/vendors programming abilities and explains front-end programming options (both custom and generic).
1-2 years Customer service experience
Prefer 1-2 years MEA experience
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Existing Teleworkers only
ADDITIONAL JOB INFORMATION
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 candidate'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