Customer Service Representative

Aetna is a diversified health care benefits companies, providing individuals, employers, health care professionals, producers, and others with innovative benefits, products, and services. It is serving an estimated 46.7 million people with information and resources to help them make better decisions about their health care.

The After Hours department is a multi-skilled workgroup that encompasses the tasks of Member Services, Prior Authorization, Pharmacy and Transportation scheduling.

* Answers questions and resolves issues based on phone calls from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. * Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. * Performs non-medical research including eligibility verification, COB, and benefits verification. * Resolve conflicts while maintaining good constituent relationships * Maintains focus on achieving a positive outcome for constituents and Aetna * Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirement * Supports the administration of the pre-certification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures. * Protects the confidentiality of member information and adheres to company policies regarding confidentiality

**Background/Experience desired:** 1-3 years of professional experience as a call center, medical assistant, office assistant or other clinical experience required. **Education** The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience. **Technology Experiences** Technical - Imaging **Required Skills** * Service/Handling Service Challenges/ADVANCED * Service/Providing Solutions to Constituent Needs/FOUNDATION **Desired Skills** * Service/Creating a Differentiated Service Experience/ADVANCED * Service/Demonstrating Service Discipline/FOUNDATION * Service/Working Across Boundaries/ADVANCED **Additional Job Information** Candidate must be willing to work 2nd shift and will be assigned to work a minimum of 3 holidays per calendar year. The After Hours department will observe daylight saving (DST) 8 months of the year the start time for 2nd shift is 1:55 PM and the reaming 4 months the start time is 2:55 PM Arizona local time zone. The shifts available consist of 5x8: The 5x8 shift will offer consecutive days off. The candidate will be scheduled to work a Saturday or Sunday or both as part of their normal schedule. Shift Differential.