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Sr Integrated Svcs Spec

Primary Location: New York, New York
Additional Locations: NY-New York
Responsible for servicing customers by processing enrollment forms and questions, accounts receivable inquiries, or claims and adjustments. Develops and enhances customer relationships by routinely resolving customer inquiries and concerns and striving to

Fundamental Components:
  • Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail to respond to inquiries and resolve concerns, including those of a difficult and challenging nature; takes responsibility for following through and bringing outstanding issues to closure; tactfully handles supervisory calls and difficult customer interactions.
  • Processes routine to complex claims for all physician, facility and specialty areas, including those requiring difficult manual adjudications, stop loss claims, high dollar claims and adjustments, in accordance with company policies and procedures.
  • Researches and updates customer information by effectively using the "Essentials" on-line resource library and Navigator to resolve enrollment and accounts receivable questions and to process claims and adjustments in response to inquiries including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility; creates, updates and monitors enrollment, accounts receivable, customer service and claims payment training information; quickly assesses and applies information to various customer situations.
  • Investigates, analyzes, and resolves outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems through analysis and evaluation of information and alternate solutions.
  • Anticipates and quickly identifies customer needs; acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making; assists other team members; takes ownership for problem resolution.
  • Performs peer audits including phone quality reviews through the Witness program and claims quality reviews. Tests new benefit plans, contracts, rule banks and operational enhancements. Monitors and reviews team operational reports including ACD MAX and Navigator phone reports; effectively uses the tools to drive process improvements and enhance results; assists with phone scheduling
  • Manages work distribution including paper enrollments, claims, correspondence and work queues; monitors and adjusts workflow accordingly for load balance purposes; employs expert knowledge of all products. Maintains phone and enrollment, accounts receivable or claims quality, production standard and performance levels while working on customer-related and other special projects.
  • Assesses training needs within the team; serves as a training resource, mentor and coach to others, particularly new hires; identifies and shares best practices.
  • Seeks avenues for developing professional expertise and actively pursues new learning opportunities, which support the company's goals and objectives. Demonstrates, advocates and reinforces a positive team environment, professionalism and the need to present a positive image of the company when interacting with customers.

Background Experience:
  • Experience in providing constructive feedback and serving as a training resource, mentor and coach
  • Minimum of three years’ recent and related Contact Center enrollment, accounts receivable or customer service and claims processing equivalent experience
  • Experience with a Windows-based pc environment and in utilizing common office applications, including email, MS Word, Excel, and PowerPoint.
  • High School Diploma or GED preferred, but not required

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. Click here to review the benefits associated with this 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

Click To Review Our Benefits (PDF)


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