Electronic Eligibility Consultant

Please note that this in-office Aetna position is open to candidates residing within a commutable distance from either our Omaha, NE or Hartford, CT offices.

POSITION SUMMARY

As an Electronic Eligibility Consultant, you will, under general supervision, verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns. Through your work, you will maintain enrollment databases and coordinates electronic transfer of eligibility data.

Fundamental Components of the Electronic Eligibility Consultant role include, but are not limited to:

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, tap 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. 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. Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information. Completes, required set-up policy and eligibility screens in order to activate system processing of plan benefits. Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e. ID cards). Ensures that legislation and compliance have been properly adhered to with regards to Plan Sponsor and/or member activity. Utilizes and interprets online resources to understand customers account structure and benefits. May assist with the development of such resources. Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services. Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPPA compliance requirements. BACKGROUND/EXPERIENCE desired:

1-3 years of professional Customer Service experience (telephonic or face-to-face) required. 1-3 years of professional Data Entry/Data Administration experience required. Attention to detail and accuracy. Problem solving skills. Strong organization skills. Understands the impact of work to others teams and downstream support areas. Ability to analyze and research data to make appropriate corrections as necessary. Sound understanding of system errors and how to resolve efficiently. Strong verbal and written communication 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 - Administration / Operations/Data Entry/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Adobe Acrobat Suite v5/1-3 Years/End User

REQUIRED SKILLS

General Business/Communicating for Impact/ADVANCED

Service/Working Across Boundaries/ADVANCED

Service/Creating a Differentiated Service Experience/ADVANCED

DESIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

General Business/Maximizing Work Practices/ADVANCED

Service/Handling Service Challenges/ADVANCED

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.

Employment Type Regular Career Band Description Business Support & Technical