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National Business Health Concierge

Primary Location: Fresno, CA
Additional Locations: CA-Fresno
At Aetna, we are currently recruiting caring, compassionate and curious Health Concierge Representatives who are willing to be problem solvers and champions for our members’ best health to help guide the members along a clear path to care. We work to build trust with our members and take pride in doing the right thing for the right reason. If you are passionate and empathetic about the people you serve, this position may be a fantastic career opportunity for you!

The Health Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.

Fundamental Components:
  • National Business Health Concierge’s (HC’s) create an emotional connection with our members by understanding and engaging the member to the fullest. HC’s build a trusting relationship with the member by taking accountability to fully understand the members’ needs.
  • They identify member needs beyond the initial inquiry by answering the unasked questions.
  • HC’s answers questions and resolve issues as a ‘single-point-of-contact’ based on phone calls, letters, emails, Internet, chat and outreach programs from members.
  • They make financial decisions to resolve member issues using customer service threshold framework.
  • They collaborate with colleagues and co-workers to deliver a world-class member experience.
  • The HC guides and educates the member through various elements of their benefit plan information and available services created to enhance the overall customer service experience.
  • HC’s take ownership and resolve issues without or with limited management intervention.
  • They have knowledge of Aetna policy, procedure and resources to comply with regulatory guidelines.
  • National Business Health Concierges (HC's)
  • Answer questions and resolve issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.
  • Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
  • Fully understands the member’s needs by building a trusting and caring relationship with the member.
  • Anticipates customer needs.Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
  • Uses customer service threshold framework to make financial decisions to resolve member issues.
  • Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).
  • Utilizes all relevant information to effectively influence member engagement.
  • Takes immediate action when confronted with a problem or made aware of a situation.
  • Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
  • Identifies member needs beyond the initial inquiry by answering the unasked questions.
  • Resolves issues without or with limited management intervention.
  • Provides education to members to support them in managing their health.
  • Responds quickly to meet customer needs and resolve problems while avoiding over-committing.
  • Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.
  • Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.
  • Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.

Background Experience:
  • To be successful, a Health Concierge require strong ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, changing environment.
  • In addition to excellent computer skills, top candidates will possess critical thinking, professionalism, strong listening and organizational skills and demonstrate empathy.
  • A minimum of two years of Customer Service experience in a service environment, such as a call center or retail location preferred.
  • Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
  • Effective organizational skills and ability to manage multiple tasks.
  • Effective communication skills, both verbal and written Associate's degree or equivalent work experience.

Additional Job Information:
Our customer service area is the very important first line of contact with the customers. They work with members, providers and plan sponsors to help them understand our products and services. HC’s provide a human connection when it is needed most. Our customer service team consists of talented, dedicated people with the skills to make a difference in the lives of our customers. The setting is fast-paced and customer satisfaction is a top priority. People who thrive in our organization can handle multiple tasks while maintaining positive and professional outlook. Our work environment is engaging and diverse. Employees are encouraged to satisfy professional ambitions, take pride in their contributions and share in our success.

Innovative Thinking and “Change Agent” - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services. Strong analytical skills and innovative problem solving abilities. Strong negotiation and collaboration skills. In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other employee benefits), related financials, legal/regulatory requirements. Empathy towards customers' needs and concerns. Ability to maintain accuracy and production standards. Technical skills. Attention to detail and accuracy.

Required Skills:
Service - Creating a Differentiated Service Experience, Service - Providing Solutions to Constituent Needs, Service - Working Across Boundaries

Desired Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, Technology - Leveraging Technology

Functional Skills:
Communication - Member communications, Customer Service - Customer Service - Member Services - Traditional products, Customer Service - Customer service - production environment

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Foundation Classes, Desktop Tool - Microsoft Outlook

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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 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.


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