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Senior Plan Sponsor Service Consultant

Primary Location: New York, NY
Additional Locations: NY-New York
Responsible for the processing of eligibility data into Aetna systems required for claim payment and product production (i.e., ID Cards). Ensures received funds are allocated accordingly across benefit and corresponding account structure, and validates posting for financial reporting purposes. This position typically performs a minimum of 2 plan sponsor service functions on a daily basis, which may include enrollment, collections, billing, accounts receivable, installation and plan sponsor customer service; including most, or all of the following fundamental components.

Fundamental Components:
  • Performs multiple functions including enrollment, billing, accounts receivable, collections, installation, and plan sponsor customer service for an assigned book of business.
  • Performs quality assurance on billing and enrollment transactions on an as needed basis.
  • Processes enrollment transactions and ensures appropriate interface with all essential downstream systems; consults with other team functions to coordinate the release of eligibility, account structure and benefit information.
  • Consults with plan sponsors regarding billing format and payment arrangements in determining system requirements vital for account reconciliation.
  • Responds to plan sponsor inquiries or requests, including issues pertaining to Aetna applications used by Plan Sponsor Services, i.e., EZLink, EZ Enroll, etc.
  • Researches, resolves and responds to eligibility and/or billing inquiries generated from Plan Sponsors, third party vendors, Service Centers, marketing offices, and other external entities with which Aetna has a business partnership.
  • Utilizes and interprets online resources to understand Plan Sponsor account structure and benefits; applies technical policy, legislation, Plan Sponsor account structure and benefit guidelines to eligibility decisions.
  • Coordinates validation of eligibility on all HMO fully-insured and self-insured customers.
  • May participate in pre- and post-sale installation meetings in order to evaluate customer’s billing requirements, payment arrangements and historical information.
  • Ensures remittances are posted accurately across various benefits and legal entities via appropriate Aetna AR systems.
  • Reviews aging reports to coordinate collection and reconciliation activities which may include cancellation of overdue customers in accordance with pre-established market segment policies.
  • Reviews and audits plan sponsor member listings, other payment documentation, and corresponding payment history and determines if any discrepancies exist in billing statements; reconciles plan sponsor remittances to facilitate accurate data feeding to downstream systems.
  • Researches and resolves revenue adjustment issues and reports correction to appropriate contacts.
  • May set up policy and eligibility screens in Aetna systems to enable electronic processing.
  • May verify accuracy and coordinate distribution of ID Cards.
  • May participate on or lead team, regional or company wide projects.
  • May provide technical SME support and/or limited assistance with operational oversight in supervisor's absence for various administrative functions.

Background Experience:
  • Experience of college degree

Additional Job Information:
  • Ability to analyze financial information and reports.
  • Ability to prioritize tasks/work effectively.
  • Strong verbal and written communication skills.
  • Strong organization skills.
  • Math and accounting skills.
  • Problem solving skills.
  • Attention to detail and accuracy.

Required Skills:
General Business - Applying Reasoned Judgment

Desired Skills:
Leadership - Collaborating for Results, Service - Handling Service Challenges

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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