Aetna Customer Svc Consultant in Shanghai, China
Req ID: 50861BR
Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.
Provide operational and logistical support to Clinical Case Managers, working in partnership to coordinate the delivery of pre-authorisation services. Rapidly investigate, review and adjudicate claims in advance of treatment taking place.
Fundamental Components & Physical Requirements:
Working within the Member Assistance contact center, investigate, consider and pre-authorise treatment 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 at all times.
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 and service level.
Take ownership for progression of own caseload, maintain communication, remove barriers, avoid delays.
Follow appropriate escalation process for high dollar claims.
Investigate claims for possible abuse and fraud.
May facilitate training and coaching when considered topic subject matter expert.
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.
Previous experience in a Clinical or Medical Assistance Environment highly desirable
Proven telephone customer service experience
Highly beneficial to have worked in an insurance environment
· Clinical qualification would be high beneficial but not essential
· Fluent in English and highly desirable to have Arabic language skills
Additional Information (not mandatory to complete):
Working knowledge of Word, Excel, Email and Internet.
Excellent customer service skills with a strong command of written and spoken English.
Good communicator with strong organisational and problem solving skills.
This role will have different work patterns to the normal Aetna Dubai contracts. The work patterns are being finalized.
Job Function: Customer Service