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Resource Advocate

Primary Location: Houston, TX
Additional Locations: TX-Houston
Aetna’s Engagement Hub is staffed with a member centric team serving as the front line of customer service for Corporate Care Management.

Our Resource Advocates will demonstrate a highly energetic blend of health care navigator, coach, care coordinator, and customer support representative. The Resource Advocate serves as the first point of contact for many Aetna members qualifying for and needing Care Management services. The Resource Advocate is instrumental in enrolling Aetna members in Corporate Care Management programs, appropriately assessing member’s needs and connecting them to resources to help, while also serving as air traffic control for Corporate Care Management programs. The Advocates primary focus is to handle inbound and outbound calls, gather the required information to appropriately assess the member’s situation, and to provide the member with the resources and assistance needed to support them through their health journey.

Fundamental Components:
  • Eagerly embraces new and ever-changing work expectations, including a test and learn environment where workflows are adjusted often, new systems are introduced, and success is driven by continuous learning and quality improvement of each team member as well as the team as a whole
  • Thoroughly understands the importance of Care Management services, community-based resources, and both episodic and long-term care interventions. Easily communicates this information to members, caregivers, providers, and other CVS Health employees
  • Conducts triage, connecting members with appropriate care team personnel including the Telephonic Care Manager, Social Worker, and when appropriate the full interdisciplinary team
  • Easily describes the benefits of Care Management, empowering members to agree to Aetna Care Management services and then enrolling them in the appropriate program
  • Effectively supports members during calls, managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate
  • Comfortable speaking to providers, assisting members with appointment and transportation scheduling, and when needed completion of online or paper applications
  • Effectively meets daily metrics with speed, accuracy, and a positive attitude while maintaining focus on not only the number of members served but the quality of service provided to each member
  • Responsible for serving as an Engagement Specialist, meeting all metrics required for this position based on the number of hours spent focused on enrolling members to Care Management
  • Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA. Accurately documents member interactions in Aetna’s health record, maintaining accurate and complete documentation of all inquiries
  • Ability to master various systems and clinical platforms
  • Ability to be agile, managing multiple priorities and adapting to change with enthusiasm
  • Determined to build strong relationships with peers and our Aetna members
  • Demonstrates an outgoing, enthusiastic, and caring presence over the telephone
  • Willingness to enthusiastically take on special projects and adapt work assignments as needed for the greater good of the Engagement Hub

Background Experience:
  • Achievement oriented; motivated by achieving efficiency, meeting productivity goals, and aligning work to program objectives
  • At least 2 years of experience preferably in health coaching, information and assistance services, or care coordination
  • Familiarity with healthcare services preferred
  • Demonstrated strong communication, active listening, and questioning skills
  • Demonstrated ability to learn new systems and workflows and in turn consistently and accurately follow processes and documentation requirements. Multiple systems and workflows must be mastered to be successful in this position
  • Call center experience preferred
  • Familiarity with basic medical terminology preferred
  • Flexibility to work a set schedule that falls between 8:00 am – 8:00 pm
  • Computer proficiency, strong keyboarding skills, and the ability to multi-task (type and talk) is required – knowledge of Microsoft Word, Outlook, and Excel preferred
  • Bilingual (Spanish) is a bonus

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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