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Customer Service Representative (2nd shift)
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | phoenix, Arizona |
About this job
This is a great opportunity for someone looking to work non-traditional hours, you will learn a lot about Healthcare and Managed Care and there are opportunities to grow within Aetna.
Candidate must be willing to work 2nd shift and will be assigned to work a minimum of three holidays per calendar year. The start time for the next four months is 2:55 PM and the remaining eight months of the year the start time is 1:55 PM Arizona local time zone due to daylight saving time. You will work five, 8 hour shifts per week including both Saturday and Sunday shifts with two consecutive days off during the week. There is a shift differential tied to this position.
POSITION SUMMARY
After Hours department is a multi-skilled workgroup that encompasses the tasks of Member Services, Prior Authorization, Pharmacy and Transportation scheduling.
Fundamental Components:
(-) 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 experience as a medical assistant, office assistant or other clinical experience, call center.
EDUCATION
The level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
REQUIRED SKILLS
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Service/Handling Service Challenges/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION
DESIRED SKILLS
General Business/Turning Data into Information/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
ADDITIONAL JOB INFORMATION
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.
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
Candidate must be willing to work 2nd shift and will be assigned to work a minimum of three holidays per calendar year. The start time for the next four months is 2:55 PM and the remaining eight months of the year the start time is 1:55 PM Arizona local time zone due to daylight saving time. You will work five, 8 hour shifts per week including both Saturday and Sunday shifts with two consecutive days off during the week. There is a shift differential tied to this position.
POSITION SUMMARY
After Hours department is a multi-skilled workgroup that encompasses the tasks of Member Services, Prior Authorization, Pharmacy and Transportation scheduling.
Fundamental Components:
(-) 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 experience as a medical assistant, office assistant or other clinical experience, call center.
EDUCATION
The level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
REQUIRED SKILLS
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Service/Handling Service Challenges/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION
DESIRED SKILLS
General Business/Turning Data into Information/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
ADDITIONAL JOB INFORMATION
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.
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
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