Aetna A1A Proactive Care Management Associate in New Albany, Ohio
Req ID: 72791BR
The Sr. Service Advocate serves as the Single Point of Contact for handling member service inquiries, issues, and education via telephone, internet, web-chat, email, written correspondence, walk-ins, and “on-boarding” programs. Acts with fast knowledge using integrated service tools. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of the Consumer Business suite of services.
Fundamental Components included but are not limited to:
Provides end to end accountability for the member. Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, letters, email, internet, chat, outreach programs, and walk-ins from members. Provides information based on Consumer Business or business unit specific suite of services. Explains member plan of benefits, member’s rights and responsibilities in accordance with contracts and contracted arrangements, claim status information, full range of benefit coverage, plan eligibility, premium payment and billing. Builds a trusting relationship with the member by taking accountability to fully understand the member’s needs. Walk members through programs, Aetna tools and resources to support better health care consumer behaviors. Initiates out-reach/welcome calls during “on-boarding” to educate member of available tools, plan programs, on-line and mobile application, resources, etc. Ability to resolve complex issues with sensitivity and discretion. Takes ownership of each member contact to resolve their issues and connect them with additional services as appropriate. Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes. Uses communication skills to build relationships with both internal and external members/constituents. Uses applicable system tools and resources to produce and/or quality letters and spreadsheets in response to inquiries received. Handle multiple functions and/or multiple products while maintaining and/or exceeding performance standards. Identifies issues that need to be escalated appropriately and offers suggestions for resolution. Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents. Supports individual, team and business goals and initiatives; accepts ownership for individual results. Handles escalated calls and issues. Assist with research and participate or lead special projects/initiatives addressing service issues and support of staff. Demonstrates strong member focus and utilizes all available resources to ensure prompt member satisfaction within the department or engaging appropriate department. Demonstrates functional expertise and leadership ability. Serves in a Lead role for team members and may act as a backup to supervisor, Through in-depth analysis, identifies complaint trends and any emerging member service issues and works to develop solutions to address potential problems.
Qualifications Requirements and Preferences:
Ability to creatively solve members’ problems and have desire to help and advocate for them.Experience with premium payment and billing.Prior experience working directly with members / consumers – preferably in a leading retail setting or call center setting.Ability to absorb and apply new and changing information.Ability to make effective and independent decisionsAbility to multitask, prioritize and effectively adapt to a fast paced changing environmentStrong listening and interpersonal skills; skilled at developing and maintaining effective working relationships.Demonstrated organizational and communication skills required.Experience with coaching and mentoring others. Some college preferred.High School Diploma or G.E.D.
Additional Job Information:
Strong communications skills.Strong analytical skills focusing on accuracy and attention to detail.Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.Understanding of medical terminology.Ability to maintain accuracy and production standards.Negotiation skills.Problem solving skills.
Benefit eligibility may vary by position.
Job Function: Customer Service
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
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