Job Snapshot

Location:

 Phoenix, AZ 85040 (Map it!

 Loading Map... )

Employee Type:

Full-Time

Industry:

Healthcare - Health Services Insurance Managed Care

Manages Others:

No

Job Type:

Customer Service
 Health Care
 Insurance

Education:

None

Experience:

At least 3 year(s)

Relocation Covered:

No

Post Date:

3/10/2010Contact Information

Ref ID:

27745005_69171543 

Description About Our Company 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
 
 JOB GROUP SUMMARY 
Customer Service is the important first-line of contact with customers, setting the tone for how members, doctors and plan sponsor groups view our company. It provides members with the right information at the right time to help them make better decisions about their health and health care. 
 
EDUCATION 
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience. 
 
FUNCTIONAL WORK EXPERIENCE 

 Customer Service: Customer Service - Member Services - HMO products 

 Customer Service: Customer service - production environment 

 Customer Service: Complaints, grievances & appeals 
 
POSITION SUMMARY 
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 complaints member/provider), grievance and appeals (member/provider) via target system. Educates providers on our self-service options Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits. 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 ensure 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. Exhibits behaviors outlined in Customer Service Representative Competencies 
 
ADDITIONAL JOB INFORMATION 
Currently hiring for the following shift: 12:30 pm - 9:00 pm. 
Must be available to work any shifts between the hours of 7:00 am and 9:00 pm. 
 
Healthcare experience a plus. 
 
Bilingual (Spanish) preferred. 

Requirements REQUIRED SKILLS 

 Perform intake calls from members 

 Perform intake calls from providers 

 Providing Solutions to Constituent Needs Maximizing Work Practices 
 
DESIRED SKILLS 

 Educate providers on contract requirements 

 HMO 

 Explain member's rights and responsibilities in accordance with their contract 

 Medicare Advantage Prescription Drug Plan Handling Service Challenges 

 Demonstrating Service Discipline 

 

Schaller Anderson is an affiliate of Aetna.  We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position. 
We conduct pre-employment drug and background testing. 
Schaller Anderson does not permit the use of tobacco related products or drugs in the workplace. No agencies, please. 
Schaller Anderson, an affiliate of Aetna, is an Equal Opportunity/Affirmative Action Employer. M/F/D/V 
  
We are committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Our Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status. No search firms please. 

 

Click Here to Find Salary Information for this Job >>

 


 Apply Now >> Save it

 |Email It

 | Print it| 

  SiteCatalyst code version: H.0.