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Eligibility Consultant

Primary Location: Harrisburg, PA
Additional Locations: PA-Harrisburg
Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.

Fundamental Components:
  • 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.

Background Experience:
  • 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.

Additional Job Information:
  • Ability to analyze and research data to make appropriate corrections as necessary.
  • Understands the impact of work to other teams and downstream support areas.
  • Strong verbal and written communication skills.Strong organization skills.
  • Problem solving skills.Attention to detail and accuracy.

Required Skills:
General Business - Communicating for Impact, Leadership - Collaborating for Results, Service - Handling Service Challenges

Functional Skills:
Customer Service - Customer Service - Member Services - HMO products

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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