Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
As a Customer Service Representative, you will care for our customers by researching issues, documenting outcomes, resolving inquiries, and delivering a high level of customer satisfaction.
Responsibilities:
- Creates an emotional connection with members by understanding and engaging them to champion for their best health.
- Takes accountability to fully understand members' needs by building a trusting and caring relationship.
- Anticipates customer needs.
- Provides customers with related information to answer unasked questions.
- Uses customer service threshold framework to make financial decisions to resolve member issues.
- Explains members' rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints, grievance, and appeals.
- Educates providers on self-service options and assists with credentialing and re-credentialing issues.
- Responds to requests received from Aetna's Law Document Center regarding litigation.
- Assists in preparation of complaint trend reports.
- Assists in compiling claim data for customer audits.
- Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility.
- Handles incoming requests for appeals and pre-authorizations.
- 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.
Requirements:
- 3 days onsite Tuesday-Thursday in Franklin, TN
- 1-3 years Customer Service experience in a transaction-based environment
- Demonstrated ability to be empathetic and compassionate
- Experience in a production environment
Preferred Qualifications:
- Proficient in Excel
- SQL experience a plus
- Insurance Knowledge - Plus
Education:
- High School Diploma
Anticipated Weekly Hours: 40
Time Type: Full-time
Pay Range: $17.00 - $28.46
Benefits: We offer a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.