Eligibility ConsultantPrimary Location: Harrisburg, PA
Additional Locations: PA-Harrisburg Apply
- Responds, researches, and resolves eligibility and/or billing related issues involving member specific information
- Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
- Monitors daily status reports assessing output for developing trends potentially impacting service levels.
- Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
- Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
- Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
- Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.
- Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).
- Determines and communicates standard service charges to internal/external customers related to paper eligibility activities
- May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
- Attention to detail and accuracy
- Problem solving skills. Strong organization skills
- Understands the impact of work to other teams and downstream support areas
- Ability to analyze and research data to make appropriate corrections as necessary
- Strong verbal and written communication skills.
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.Sign Up
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.