Customer Service Representative

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Manage customer service inquiries and issues through telephone, online platforms, or written communication.

• Interact with, advise, and inform members according to their needs, preferences, and comprehension of Aetna plans, tools, and resources.

• Address questions and resolve problems for members, providers, and plan sponsors.

• Direct any necessary rework to the appropriate personnel.

• Maintain documentation and track interactions with members, providers, and plan sponsors.

• Assist members in navigating benefits plans and Aetna policies while adhering to regulatory standards.

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

• Anticipate customer requirements and provide relevant information regarding plans, benefits, and self-service options.

• Employ the customer service threshold framework to make informed financial decisions and address member concerns.

• Clarify members’ rights and responsibilities as outlined in the contract.

• Process incoming requests for appeals and pre-authorizations not managed by Clinical Claim Management.

• Analyze member claim histories to accurately monitor benefit maximums, coinsurance, and deductibles.

• Perform additional tasks as required.

⛳️ Requirements

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

• At least 1 year experience in health insurance, specifically in Medicaid, Medicare, and/or Medicare Advantage.

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

• Availability to work a flexible schedule Monday through Friday from 8am to 6pm Arizona Time.

• Demonstrated understanding of medical terminology.

• Previous experience in a healthcare setting.

• Strong organizational and time management abilities.

• Excellent verbal and written communication skills.

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

• Prior experience with Medicare.

• High school diploma or GED required.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting colleagues’ physical, emotional, and financial health.

• Comprehensive benefits package available for eligible full-time colleagues.