Bilingual Health ConciergePrimary Location: High Point, NC
Additional Locations: CA-Fresno, IL-Chicago, MI-Grand Rapids, NC-High Point Apply
- 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.
- Answers questions and resolves 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.
- Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.
- Partners with other departments to deliver client specific presentations.
- Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.
- Works collaboratively with colleagues to deliver the best customer experience.
- Seeks to understand the customer, including circumstances, problems, expectations and needs.
- Asks probing questions to identify the underlying customer needs Appropriately transitions conversations to explore possibilities for extending customer interactions.
- Guides members to the appropriate health resource.
- Offers alternatives where appropriate Acts with the best interest of customer in mind and central to all interactions.
- Collaborates with colleagues and co-workers to deliver a world class customer experience.
- Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.
- May participate in preparation and presentation of client specific presentations.
- May track and trend data.
- Coaches, trains and assists in the development of call center staff, as required.
- Participates in and/or leads special projects/initiatives addressing service issues, as necessary.
- Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.
- 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.
- Bilingual- English/French-Canadian or French Required
- 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
- 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.
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