Senior Plan Sponsor Service ConsultantPrimary Location: New York, NY
Additional Locations: NY-New York Apply
- 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.
- Experience of college degree
- 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.
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