Aetna Customer Service Consultant in Singapore, Singapore
Req ID: 54859BR
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 processes. Position Summary/MissionReviews and adjudicates claims in accordance with claim processing guidelines. Handles customer service inquiries and problems via telephone, internet or written correspondence. Act as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Acts as end-to-end contact for clients experiencing claim and/or customer service problems. Fundamental Components & Physical Requirements include but are not limited to · Working within the Member Assistance contact center, investigate, consider and pre-authorize 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 always 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 prioritize 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. Background/Experience Desired· 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. Education and Certification Requirements· Clinical qualification would be highly beneficial but not essential· Fluent in English language communication skills & Bahasa / Mandarin desired due to territory needs. Additional Information · Working knowledge of Word, Excel, Email and Internet.· Competent typist.· Excellent customer service skills with a strong command of written and spoken English.· Good communicator with strong organizational and problem-solving skills.
Job Function: Customer Service
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.