We are hiring a customer service representative to manage customer queries and complaints. You will also be asked to process orders, modifications, and escalate complaints across a number of communication channels. To do well in this role you need to be able to remain calm when customers are frustrated and have experience working with computers.
Bring your heart to Aetna Health Every one of us at Aetna Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at Aetna Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
This position is work from home and you must live in the State of Oklahoma.
Must be able to attend 4 weeks of training (virtual) between the hours of 8-5 CST.
After training, the permanent schedule is an Monday-Friday and can start as early as 7 am CST and end as late as 7 pm CST.
Responsibilities:
- Maintaining a positive, empathetic, and professional attitude toward customers at all times.
- Responding promptly to customer inquiries.
- Communicating with customers through various channels.
- Acknowledging and resolving customer complaints.
- Knowing our products inside and out so that you can answer questions.
- Processing orders, forms, applications, and requests.
- Keeping records of customer interactions, transactions, comments, and complaints.
- Communicating and coordinating with colleagues as necessary.
- Providing feedback on the efficiency of the customer service process.
- Managing a team of junior customer service representatives.
Position Summary
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Provide excellent customer services for high volume in bound provider calls for the Claims Inquiry/Claims Research team. Extensive claims research on multiple platforms to assist providers with payment questions.
- 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 & assists providers on our self-service options. Assists providers with credentialing and re-credentialing and contracting questions and issues.
- 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.
Required Qualifications
- MUST live in the state of Oklahoma full-time
- Familiarity with Microsoft Office products
- Experience in highly transactional call center environment
- Excellent customer service and critical thinking
- High speed internet access (25 mbps or higher) and consistent connection
- Work location must be set up with a direct connection to the router (NOT Wi-Fi). We provide a 6 ½ foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable.
Education
High School diploma or GED equivalent.
