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Aetna is now a CVS Health Company

Network Relations Specialist

Primary Location: W. Sacramento, CA
Additional Locations: CA-W. Sacramento
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Description:
Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, plan design, credentialing process or status, and claims or compensation process or status. Supports the maintenance of contract or demographic data.

Fundamental Components:
  • Triages routine provider issues and internal inquiries regarding policies and procedures, credentialing or claims status, orientation activities, and database or portal information or usage.
  • Escalates issues as appropriate.
  • Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
  • Performs credentialing support activities as needed.
  • Educates providers on portals, protocols, policies, procedures, and services to enhance the overall provider experience.
  • May assist with or perform standard provider recruitment or contracting or re-contracting functions and discussions.


Background Experience:
  • Strong verbal and written communication and interpersonal skills.
  • Exposure to business segment specific policy, benefits, plan and product design and language.
  • Working knowledge of Medi-Cal business segment specific codes, products, and terminology.
  • 1-3 years' related customer service experience preferrably with exposure to benefits interpretation.
  • Associate's degree or equivalent work experience.


Required Skills:
General Business - Ensuring Project Discipline, Service - Creating a Differentiated Service Experience, Service - Handling Service Challenges

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Turning Data into Information, Service - Working Across Boundaries

Functional Skills:
Communication - Communication Delivery - Public Speaking, Customer Service - FE Customer Service - Provider - HMO, Network Management - Provider relations

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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