Customer Service Representative


(Detroit, Michigan)
Full Time Travel Required
Job Posting Details
About Aetna
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.
Michigan Member Services Rep handles customer service inquiries and problems via telephone, internet or written correspondence. Member inquiries are basic and routine in nature. Were looking for people who are passionate about providing exceptional customer service and would like to be part of our member services team that supports the needs and care of our members.
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. 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 providers on our self-service options; Assists providers with credentialing and re-credentialing issues. Handles extensive file review requests. Assists in preparation of complaint trend reports. 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. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to maintain accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. Ability to multi-task to accomplish workload efficiently. Analytical skills. Ability to maintain accuracy and production standards. Understanding of medical terminology, a plus. Attention to detail and accuracy.
Ideal Candidate
**Background/Experience desired:** Minimum of one year customer service experience. Experience in a production environment, call center preferred. Customer Service experience in a transaction based environment such as a call center, healthcare or retail location. Exceptional communication skills, written and verbal. Demonstrated competencies, problem solving and critical thinking skills. Computer and keyboard navigation skills. **Education** The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience. **Functional Experiences** * Functional - Customer Service/Customer Service - Member Services - Traditional products/1-3 Years * Functional - Communications/Member communications/1-3 Years * Functional - Customer Service/Customer service - transaction based environment/1-3 Years * Functional - Customer Service/Customer service - production environment/1-3 Years **Technology Experiences** * Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User * Technical - Desktop Tools/Microsoft Word/1-3 Years/End User * Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User **Required Skills** * Service/Creating a Differentiated Service Experience/Advanced * Service/Handling Service Challenges/Advanced * Service/Providing Solutions to Constituent Needs/Foundation **Desired Skills** * Benefits Management/Interacting with Medical Professionals/Foundation * General Business/Maximizing Work Practices/Advanced * Service/Demonstrating Service Discipline/Foundation **Telework Specifications:** Option for telework will be evaluated after a certain period of employment
Compensation and Working Conditions

Working Conditions

Percent of Travel Required 0 - 10%


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