Skip to main content

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.

Back to Job Navigation (Overview)

Success Profile

What makes a successful Customer Service Representative? Here are the traits we are looking for:

  • Trustworthy
  • Empathetic
  • Proactive
  • Compassionate
  • Good listener
  • Problem Solver
  • Communicator
  • Independent
  • Multi-tasker
  • Patient
  • Collaborative
  • Personable
  • Quick thinking
  • Enthusiastic

Back to Job Navigation (Success)

Benefits

  • Health

  • Paid Time Off & Disability

  • Financial

  • Wellness

  • Additional Benefits

  • Aetna’s Social Compact

    Our commitment to improve wages and medical benefits.

Back to Job Navigation (Rewards)

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

Job Details

Customer Service Rep

Primary Location: Princeton, New Jersey
Additional Locations: NJ-Princeton
Apply
POSITION SUMMARY
Handles customer services inquires and problems via telephone, internet, and written correspondence. Customer inquires as basic as routine nature.

Fundamental 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. The CSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines. (*)
Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health. (*)
Taking accountability to fully understand the members needs by building a trusting and caring relationship with the member. (*)
Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. (*)
Uses customer service threshold framework to make financial decisions to resolve member issues. (*)
Explains member's rights and responsibilities in accordance with contract. (*)
Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. (*)
Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. (*)
Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits (*)
Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. (*)
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. (*)
Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. (*)
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. (*)
Exhibits the following Customer Srvc Representative Behaviors


BACKGROUND/EXPERIENCE desired:
Experience in a production environment.
Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.


EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

ADDITIONAL JOB INFORMATION
Ability to multi-task to accomplish workload efficiently.
Analytical skills.
Ability to maintain accuracy and production standards.
Technical skills.
Oral and written communication skills.
Understanding of medical terminology.
Problem solving skills.
Attention to detail and accuracy.
Negotiation skills.


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.





Benefit eligibility may vary by position. Click here to review the benefits associated with this position.



Aetna takes our candidates'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)

Apply

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Sign up for Job Alerts

Explore This Area

Check out where you could be working if you apply.

View Map

Similar Jobs

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.