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Electronic Eligibility Consultant
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | fresno, California |
About this job
Telework Specifications:
Current Internal employees who work from home may continue to work from home, though there may be training required onsite.
POSITION SUMMARY
Coordinates electronic transfer of eligibility data and maintain enrollment databases. Customer facing interactions with clients and vendors demanding high levels of responsiveness. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns..
Fundamental Components:
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. (*) Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. (*) Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. (*) Must possess the ability to work well in a team environment with a drive for individual success and a focus on overall team success. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues. (*)
BACKGROUND/EXPERIENCE desired:
Prioritization and organization skills must be strong in order to manage assigned case load and meet responsiveness expectations. Professionalism to interact with clients, vendors and business partners as a representative of the Electronic Enrollment Department. Responsiveness to inquiries within established service level agreements. Demonstrated technical and analytical skills
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Project Management/Issue identification and analysis/1-3 Years
Functional - Learning/Development - Distance Learning/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Eligibility - Traditional/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Enrollment - Traditional/1-3 Years
Functional - Information Technology/Testing/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - EDI/EDI/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Remote Access/Hummingbird ExCeed/1-3 Years/End User
Technical - Aetna Applications/EZConnect / Aetna Data Transfer/1-3 Years/End User
REQUIRED SKILLS
Service/Creating a Differentiated Service Experience/ADVANCED
Service/Working Across Boundaries/ADVANCED
Technology/Leveraging Technology/ADVANCED
DESIRED SKILLS
Leadership/Collaborating for Results/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/MASTERY
ADDITIONAL JOB INFORMATION
Demand is increasing for this type of position - growth opportunities for right candidates
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical
Current Internal employees who work from home may continue to work from home, though there may be training required onsite.
POSITION SUMMARY
Coordinates electronic transfer of eligibility data and maintain enrollment databases. Customer facing interactions with clients and vendors demanding high levels of responsiveness. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns..
Fundamental Components:
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. (*) Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. (*) Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. (*) Must possess the ability to work well in a team environment with a drive for individual success and a focus on overall team success. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues. (*)
BACKGROUND/EXPERIENCE desired:
Prioritization and organization skills must be strong in order to manage assigned case load and meet responsiveness expectations. Professionalism to interact with clients, vendors and business partners as a representative of the Electronic Enrollment Department. Responsiveness to inquiries within established service level agreements. Demonstrated technical and analytical skills
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Project Management/Issue identification and analysis/1-3 Years
Functional - Learning/Development - Distance Learning/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Eligibility - Traditional/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Enrollment - Traditional/1-3 Years
Functional - Information Technology/Testing/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - EDI/EDI/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Remote Access/Hummingbird ExCeed/1-3 Years/End User
Technical - Aetna Applications/EZConnect / Aetna Data Transfer/1-3 Years/End User
REQUIRED SKILLS
Service/Creating a Differentiated Service Experience/ADVANCED
Service/Working Across Boundaries/ADVANCED
Technology/Leveraging Technology/ADVANCED
DESIRED SKILLS
Leadership/Collaborating for Results/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/MASTERY
ADDITIONAL JOB INFORMATION
Demand is increasing for this type of position - growth opportunities for right candidates
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical