Inb/Outb Queue AssocPrimary Location: Charleston, West Virginia
Additional Locations: WV-Charleston Apply
Provide comprehensive healthcare management to facilitate delivery of appropriate quality healthcare, promote cost effective outcomes and improve program/operational efficiency involving clinical issues through intake and screening.
- Performs intake from calls and faxes from members or providers regarding services
- Utilizes system to enter member information, perform non-medical research such as eligibility verification, and create authorization requests as necessary
- Places outbound calls to providers under the direction of Medical Management Nurses/Supervisors to obtain clinical information regarding requests for medical authorizations
- Supports the administration of the precertification process in compliance with various laws and regulations, as well as NCQA standards, while adhering to company policy and procedures
- Must have the ability to multi-task and effectively manage call times to accomplish the workload efficiently
- Sedentary work involving significant periods of sitting, talking, listening, and keying. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.
- 2-4 years experience as a medical assistant, office assistant or other clinical experience
- Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
- Familiarity with basic medical terminology and concepts used in utilization management
- Effective communication, telephonic, and organization skills
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Benefits Management/Interacting with Medical Professionals/ADVANCED
Service/Handling Service Challenges/FOUNDATION
General Business/Communicating for Impact/ADVANCED
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 candidates'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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.