Customer Service Representative
At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our customer service and claim teams provide a human connection when it’s needed most and are essential to turning our member’s health ambitions, big and small, into achievements. Your role will include processing claims and helping members, doctors, and companies better understand our products and services. You will be an advocate for our member’s best health by helping them get the most from their benefits, building trust and always providing a clear path to care.
- Job Type: Full-time
- Job Level: Entry Level
- Travel: No
Aetna’s minimum starting salary is $16/hr.
What makes a successful Customer Service Representative? Here are the traits we are looking for:
- Good listener
- Problem Solver
- Quick thinking
Paid Time Off & Disability
Aetna’s Social Compact
Our commitment to improve wages and medical benefits.
Customer Service Representative Quotes
You really are invested in the member… you have to be their advocate.Damon H., Senior Health Concierge Customer Service Representative
I’m very excited about the common purpose [Advocate for our members’ best health by helping get them most from their benefits, building trust and always providing a clear path to care], in the first day of training all the leaders came in and explained it. As soon as they got done talking I knew this was the company for me.Emily E., Customer Service Representative
Customer Service RepPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
58683Fundamental Components: Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. Explains member's rights and responsibilities in accordance with contract. Processes referrals to the Claim and IHAT teams for claim referrals, new claim handoffs, pre-certifications and clinical reviews. Handle complaints (member/provider), grievance and appeals (member/provider) via relevant recording/reporting system (new system to be introduced 2010). Responds to requests received from Law Document Center regarding litigation/lawsuits. Ensures compliance with requirements of regional compliance authority/industry regulator. Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. May provide lists of in-network providers and facilities upon request. Adheres to international privacy policies, practices and procedures. Background Experience: Experience in the Insurance or Financial Services industry desirable.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred.
Experience in a production environment.
High School graduate or local market equivalent.
Additional Job Information: Understanding of medical terminology.
Oral and written communication skills.
Ability to maintain accuracy and production standards.
Problem solving skills.
Attention to detail and accuracy.
Potential Telework Position: No 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 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.
Aetna has been named to Fortune’s 2018 World’s Most Admired Companies list. The company was ranked No. 4 in the “Health Care: Insurance and Managed Care” category.
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