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Customer Service Representative

At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our customer service and claim teams provide a human connection when it’s needed most and are essential to turning our member’s health ambitions, big and small, into achievements. Your role will include processing claims and helping members, doctors, and companies better understand our products and services. You will be an advocate for our member’s best health by helping them get the most from their benefits, building trust and always providing a clear path to care.

  • Job Type: Full-time
  • Job Level: Entry Level
  • Travel: No

Aetna’s minimum starting salary is $16/hr.

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Success Profile

What makes a successful Customer Service Representative? Here are the traits we are looking for:

  • Trustworthy
  • Empathetic
  • Proactive
  • Compassionate
  • Good listener
  • Problem Solver
  • Communicator
  • Independent
  • Multi-tasker
  • Patient
  • Collaborative
  • Personable
  • Quick thinking
  • Enthusiastic

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Benefits

  • Health

  • Paid Time Off & Disability

  • Financial

  • Wellness

  • Additional Benefits

  • Aetna’s Social Compact

    Our commitment to improve wages and medical benefits.

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Customer Service Representative Quotes

You really are invested in the member… you have to be their advocate.

Damon H., Senior Health Concierge Customer Service Representative

I’m very excited about the common purpose [Advocate for our members’ best health by helping get them most from their benefits, building trust and always providing a clear path to care], in the first day of training all the leaders came in and explained it. As soon as they got done talking I knew this was the company for me.

Emily E., Customer Service Representative

Job Details

Senior Customer Service Representative

Primary Location: Franklin, Tennessee
Additional Locations: TN-Franklin
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Description:
Customer Service Representative is the face of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Calls are typically non-routine in nature. Customer Service is the important first-line of contact, setting the tone for how policyholders, medical personnel and agents view our company. It provides caller with the right information at the right time to help them understand our medical review process and timeline.

Fundamental Components:
Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, letters, and internet to policyholders, medical personnel, vendors and internal customers. Activities may include providing claim status information.


Creates an emotional connection with caller by understanding and engaging to the fullest as a champion for our client's best health. Taking accountability to fully understand the policyholder's needs by building a trusting and caring relationship. Anticipates customer needs to respond with related information to answer the unasked questions, e.g. additional plan details, medical review details, required forms, etc.

Processes medical reviews, and member/provider complaints. Escalates issues as appropriate.


Initiates out-reach calls to ensure constituents expectations are met or exceeded. Through in-depth analysis, identifies complaint trends and any emerging customer service issues and works to develop solutions to address potential problems.


Educates customers on various elements of benefit plan information, medical review and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools).


Partners with other departments to meet/exceed targets. Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvements intended to enhance the overall delivery of service.


Coaches, trains and assists in the development of medical review staff. May participate and/or lead special projects/initiatives addressing service issues. May provide subject matter expertise concerning policies, procedures, and function-related applications/systems tools.

Delivers internal quality reviews. Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes. (*)


Background Experience:
Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
Experience in a production environment.
Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Associate's degree or equivalent work experience.

Additional Job Information:
Understanding of medical terminology.
Strong knowledge of benefit plans, policies and procedures.
Oral and written communication skills.
Ability to maintain accuracy and production standards.
Negotiation skills.
Technical skills.
Problem solving skills.
Attention to detail and accuracy.
Analytical skills.

Required Skills:
General Business - Communicating for Impact, General Business - Applying Reasoned Judgment, Service - Handling Service Challenges

Desired Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Demonstrating Business and Industry Acumen, Service - Providing Solutions to Constituent Needs

Functional Skills:
Administration / Operation - Data Entry, Administration / Operation - File Maintenance, Administration / Operation - Telephone / Receptionist

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
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

Click To Review Our Benefits (PDF)

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