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Customer Service Rep - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Detroit, Michigan |
About this job
POSITION SUMMARY
Michigan Duals Member Services Rep handles customer service inquiries and problems via telephone, internet or written correspondence. Member inquiries are of basic and of routine nature
Fundamental Components:
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. Responsibilities include: 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.
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 High School diploma, G.E.D. 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
Service/Demonstrating Service Discipline/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
Benefits Management/Interacting with Medical Professionals/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.
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
Michigan Duals Member Services Rep handles customer service inquiries and problems via telephone, internet or written correspondence. Member inquiries are of basic and of routine nature
Fundamental Components:
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. Responsibilities include: 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.
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 High School diploma, G.E.D. 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
Service/Demonstrating Service Discipline/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
Benefits Management/Interacting with Medical Professionals/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.
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
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