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Provider Client Advocate

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, FL-Jacksonville, OH-New Albany, TX-Arlington, TX-Houston
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Description:
The Client Advocate will serve as the Single Point Of Contact for the Plan Sponsor Human Resources personnel (Benefit Coordinator, Administrator, etc.) and respond, manage, and resolve escalated complex member level issues referred primarily through email. May include requests for claim analysis, benefit questions and plan clarification, verification and updates to terminations, hire/re-hire dates, and correction of enrollment errors. Resolves escalations and communicates resolution to the Health Plan, including action steps for long term solution, if necessary.

Fundamental Components:
  • Acts as a single-point-of-contact for Medicaid CICR (claim inquiry claim research) escalated member level issues and/or broader plan administration matters, primarily via email.
  • May include requests for claim analysis, benefit questions and plan clarification, verification and updates to terminations, hire/re-hire dates, and correction of enrollment errors.
  • Resolves escalations and communicates resolution to the Health Plan, including action steps for long term solution, if necessary.
  • Tracks and trends escalation resolution. Identifies global Health Plan specific issues and escalates to Account Manager for resolution, while staying abreast of resolution steps Participates in Health Plan conference calls to discuss member related issues or concerns and escalation trends
  • Submits requests for fulfillment orders for Health Plan and members Researches and submits member level refund requests Supports installation of new and existing accounts by attending implementation planning/process meetings.
  • Collaborates with Account Management team to achieve growth/renewal objectives and meet customer expectations Initiates and maintains partnerships with other departments throughout the organization.
  • Encourages cooperation by promoting common goals and building trust.
  • Inspires, supports, and initiates cross-functional activities Insures acknowledgement and resolution
  • Performance Guarantee goals are met within the scope of the Client Advocate role
  • Creates and updates specific Health Plan information in the Health Plan Tool Utilizes exceptional written communication skills during interaction with Health Plan, assuring clear, concise information is relayed and proper grammar and punctuation are used
  • Possesses flexibility, workload balancing, and willingness to assist team members when backlogs occur to achieve success and meet customer expectations
  • Ability to work with cross-functional business units to meet customer needs; promotes collaboration among constituents and represents a professional image of the company
  • Ability to support multiple plan sponsors


Background Experience:
  • Account Management experience and/or Plan Sponsor Service experience
  • 2- or 4-year college degree or equivalent work experience.
  • Associate's degree or equivalent work experience.


Additional Job Information:
  • 3-5 years previous experience with Call Center/Claim environment is desired


Required Skills:
Leadership - Collaborating for Results, Leadership - Engaging and Developing People, Service - Demonstrating Service Discipline

Technology Experience:
Aetna Application - QNXT

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.

Click To Review Our Benefits (PDF)

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