Customer Service Representative

This is a fully remote position, open to applicants in Arizona, +3 more states.

📋 Description

• Engage with, consult, and educate members based on their individual needs, preferences, and understanding of Aetna plans, tools, and resources.

• Address inquiries and resolve issues from members, providers, and plan sponsors.

• Direct resulting rework to the appropriate staff members.

• Document and track interactions with members, providers, and plan sponsors.

• Guide members through benefits plans and Aetna policies and procedures while ensuring regulatory knowledge is upheld.

• Foster trusting and caring relationships with members to better understand their needs.

• Anticipate the needs of customers.

• Provide information regarding plan details, benefits, and member self-service tools.

• Utilize the customer service threshold framework to make informed financial decisions in resolving member issues.

• Clarify members’ rights and responsibilities in accordance with their contracts.

• Manage incoming appeals and pre-authorizations that are not processed by Clinical Claim Management.

• Review member claim history to accurately track benefit maximums and coinsurance/deductibles.

⛳️ Requirements

• Minimum of 1 year of experience in a call center or a high call-volume environment.

• Proficient in Microsoft Office applications (Word, Excel, PowerPoint, Outlook).

• Ability to accommodate Arizona Time Zone working hours.

• High school diploma or GED required.

• Proven knowledge of medical terminology.

• Prior experience in a healthcare setting.

• Strong organizational and time management skills.

• Exceptional communication abilities.

• Capability to exhibit empathy in a professional, customer-focused manner.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support colleagues’ physical, emotional, and financial well-being.

• Comprehensive full-time benefits package.