Arizona, Colorado, Indiana, Minnesota, New York, Philidelphia, Michigan, Florida, Alaska, Alabama, West Virginia, Illinois, West Virginia, Texas, Fully remote
Aetna, a CVS Health Company's, mission is to build a healthier world by helping people realize their ambitions and achieve their goals, one person and one community at a time. We are a leading diversified health care benefits company that is helping to transform health care by providing and advancing the information, tools, and resources people need to achieve their best possible health.Read employee reviews, salaries, and benefits here
Lansing, MI
Job Description Meritain Health’s Call Center has an opening for Customer Service Representatives in our Lansing, MI office. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
Required Qualifications Creating a Differentiated Service Experience Demonstrating Service Discipline Handling Service Challenges
Preferred Qualifications Providing Solutions to Constituent Needs Working Across Boundaries
Education High School diploma, G.E.D. or equivalent experience
Tallahassee, FL
Job Description Meritain Health an Aetna/CVS affiliate has multiple openings for Customer Service Representatives in our permanent work from home role $17.50/hr wage. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature. • Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc • Maintain department established performance metrics at a meets or exceeds expectations level • Work together as a team and apply the Aetna Core Values in day-to-day operations • Creating a Differentiated Service Experience • Demonstrating Service Discipline • Handling Service Challenges • Providing Solutions to Constituent Needs • Working Across Boundaries Required Qualifications • Call center and medical terminology/insurance experience • Experience in a production environment Preferred Qualifications Please see above Education High School diploma, G.E.D. or equivalent experience Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists, and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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.
The CSR guides the member through their member's plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion our members’ best health.
Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues.
Explains ember’s rights and responsibilities in accordance with the 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.
Responds to requests received from Aetna’s Law Document Center regarding litigation; lawsuits Handles extensive file review requests.
Assists in the preparation of complaint trend report.
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 ensure 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.
Montgomery, AL ob Description
-This is an Inbound Customer Service Associate Work from the Home position.
-$1000 sign-on bonus
-Receives inbound calls from members or providers regarding medical precertification
-Sedentary work involves significant periods of sitting, talking, and data entry.
-Work requires close attention to detail to accurately follow job aids and online resources.
-Utilizes multiple Aetna systems to research and review member information for eligibility and benefits and build precertification cases when required.
-Performs non-medical research including eligibility verification, Coordination of Benefits, and benefits verification.
-Maintains accurate and complete documentation of required information.
-Utilizes effective verbal and written communication, both internally and externally, to provide first call resolution and solve complex issues.
-Protects the privacy of member information and adheres to company policies regarding confidentiality.
-Supports the administration of the precertification process in compliance with various laws and regulations, URAQ, and/or NCQA standards, where applicable, while adhering to company policy and procedures.
The Aetna CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Aetna as the client and in accordance with Medicare Part D CMS Regulations.
Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests.
Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekends,s and holiday coverage.
Customer service focus. Basic experience in MSWord and MSExcel. Familiar with medical terminology and knowledge of medical coding.
Ability to read and interpret billing documents. The position also requires an extensive amount of data entry work.
Job Description Customer Service agent in Medicaid call center, answering in-coming member and provider calls and responding to inquiries regarding benefits, eligibility, services, prior auth requirements, extra benefits,
and programs, etc.
Requires high-speed internet connectivity with secure service via ethernet cable, use of WiFi is not permitted. The company provides equipment and training.
Required Qualifications
Medicaid call-center experience, QNXT, SUV, PeopleSafe, and other relevant systems, ability to communicate effectively with members and providers orally and in written form, ability to meet performance standards, attendance requirements, and call quality goals
: Pittsburgh, PA
Job Description The role of the Customer Service Representative is to be a customer-focused, courteous, empathetic, service professional, who effectively uses knowledge of plans, products, procedures and systems to provide information and resolve issues, resulting in enhanced customer satisfaction and retention. The Customer Service Representative position is Aetna’s window to our members, providers, physicians, and hospitals. As a Customer Service Representative, the image you project over the telephone and how you handle the caller’s situation is the public’s perception of Aetna. We provide a human connection when it is needed most.
Required Qualifications -Experience in a production environment. -Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate. -Strong communication and problem-solving skills -Empathy towards customers’ needs and concerns -Strong computer navigation and typing skills -Ability to manage multiple tasks in a transaction / high volume-based environment
Fresno, CA
Job Description This is a Customer Service Work From Home Position at $17.50 per hour with a $1000 sign-on bonus. Handles provider customer service inquiries and problems via telephone, internet, or written correspondence. Customer inquiries are of basic and routine nature. – Answers questions and resolves issues based on phone calls/letters from providers. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors. – Explains members’ benefits, rights, and responsibilities in accordance with the contract to our providers. – Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues. – Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals. – Handles incoming status requests for appeals and pre-authorizations not handled by Clinical Claim Management. – Performs review of member/provider claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. – Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Required Qualifications 1-2 years of Customer Service experience in a transaction-based environment such as a call center or retail location preferred, demonstrating the ability to be empathetic and compassionate.
Plymouth, MN
ob Description Meritain Health’s Call Center has an opening for Customer Service Representatives. This is a work-from-home position at $17.50/ hour. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
Required Qualifications Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc • Maintain department established performance metrics at a meets or exceeds expectations level • Work together as a team and apply the CVS Health Core Values in day-to-day operations • Creating a Differentiated Service Experience • Demonstrating Service Discipline • Handling Service Challenges • Providing Solutions to Constituent Needs • Working Across Boundaries
Work From Home, New York
Required Qualifications
-Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating the ability to be empathetic and compassionate.
-Experience in a production environment.
This position handles customer service inquiries and problems via telephone, internet or written correspondence.
-Customer inquiries are of basic and routine nature.
\
-Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
-Triages resulting in rework to appropriate staff.
-Documents and tracks contacts with members, providers and plan sponsors.
-The CSR guides the member through their member's plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
-Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members’ best health.
-Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
-Anticipates customer needs.
-Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
-Uses customer service threshold framework to make financial decisions to resolve member issues.
Phoenix, AZ
Required Qualifications
-Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating the ability to be empathetic and compassionate.
-Experience in a production environment.
This position handles customer service inquiries and problems via telephone, internet or written correspondence.
-Customer inquiries are of basic and routine nature.
\
-Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
-Triages resulting in rework to appropriate staff.
-Documents and tracks contacts with members, providers and plan sponsors.
-The CSR guides the member through their member's plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
-Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members’ best health.
-Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
-Anticipates customer needs.
-Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
-Uses customer service threshold framework to make financial decisions to resolve member issues.
Denver, CO
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.
The CSR guides the member through their member's plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion our members’ best health.
Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
Anticipates customer needs. Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc. Uses customer service threshold framework to make financial decisions to resolve member issues.
Explains ember’s rights and responsibilities in accordance with the 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.
Responds to requests received from Aetna’s Law Document Center regarding litigation; lawsuits Handles extensive file review requests.
Assists in the preparation of complaint trend report.
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 ensure 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.
: Indianapolis, IN
Job Description Meritain Health’s Call Center has an opening for Customer Service Representatives in our Lansing, MI office. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
Required Qualifications Creating a Differentiated Service Experience Demonstrating Service Discipline Handling Service Challenge
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