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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. Read employee reviews here
Louisville, KY
Job Description
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 members’ 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.
To be successful in this role you will be managing complaints, suggestions, and comments in the queue, receiving and responding to client issues in a timely manner via email, fax, cases, and telephone. You will also be responsible for timely follow-up on requests to ensure resolution as well as ensuring complete tracking of client contact in the database to build contact history, identify trends, facilitate relationship building and provide management and client reporting. Other key responsibilities can include providing plan benefit override support at client request, providing feedback to Customer Care management on servicing incidents and developing service trends as well as partnering with the Account Management team to ensure maximum client satisfaction and issue trending. Scheduled Hours for this position: Monday – Friday 11:30 am – 8:00 pm EST (Occasional need for scheduled overtime, weekend, and holidays as determined by business need -EX: “Welcome Season”.) Future work from the home potential for outstanding team performers
Required Qualifications -1+ years of Customer Service Experience. -1+ years of Call Center Experience. -1+ years of Health Care Industry Experience.
COVID Requirements
To be successful in this role you will be managing complaints, suggestions, and comments in queue. You will receive and respond to client issues in a timely manner via email, fax, and telephone. You will also be responsible for timely follow-up on requests to ensure resolution as well as ensuring complete tracking of client contact in the database to build contact history, identify trends, facilitate relationship building and provide management as well as client reporting. Other key responsibilities can include providing plan benefit override support at client request, providing feedback to Customer Care management on servicing incidents and developing service trends as well as partnering with the Account Management team to ensure maximum client satisfaction and issue trending. We offer a comprehensive benefits package that includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays. Our application process is 2 simple steps: 1. Apply online 2. Take our Online Virtual Job Tryout (Interview Platform) to learn even more about the position
Required Qualifications 1+ years of customer service experience 2+ years of health care industry experience
Job Description As a customer care representative, you must also be able to effectively handle complaints while consistently demonstrating behaviors that contribute to Care achievement of service level goals.CCR work collaborate with internal and external business partners to provide solutions by taking responsibility for following through and bringing outstanding issues to closure on initial contact with the participant
Required Qualifications 6 months experience in a customer service role (i.e call center, retail , customer service environment or relevant military experience)
Preferred Qualifications 6 months experience in a customer service role.Healthcare-related experience and/or relevant certifications
Education Verifiable High school or GED
Job Description The Medical Management Outreach Call/Survey Representative places outbound member survey calls that are predominantly routine in nature but may require deviation from standard scripts and procedures based on individual account situations. Utilizes system applications for data entry, tracking, information gathering, and/or troubleshooting. – Researches member files using a variety of systems and references to obtain appropriate background information used in conducting call surveys; answers questions and resolves issues related to survey calls. – Meets outbound call goals and metrics. – Records survey responses in the ONTrack and QNXT Databases. Ensures responses are recorded timely and accurately in the databases. – Performs service recovery for the member, and documents actions taken and required follow-up to resolve situations. – Escalates issues accordingly when further action requires secondary sources or more senior staff. – Takes inbound calls when applicable/authorized. – Coordinates with other departments according to indicated member needs. – Triage calls as needed based on specific member responses to questions. – Collects and provides data to management for root cause and issue resolution inquiries. – Completes all required documentation in the database associated with survey input (including complaints, etc.). – May participate in special project work for the Medical Management Department.
Required Qualifications – Proficiency in a web-based data entry platform is required. – Experience in a production environment. – Computer literacy and demonstrated proficiency are required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Outlook, Word, and Excel. – Qualified candidates must be able to travel to the Phoenix office up to 10% of the time and have a valid AZ driver’s license, reliable transportation, and proof of vehicle insurance.
Required Qualifications
Customer Service experiences in a transaction-based environment such as a call center or retail location are preferred, demonstrating the ability to be empathetic and compassionate. Experience in a production environment. High School or GED equivalent.
Job Description
Customer Service Representative is the face of Aetna and impacts members’ service experience by the manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled.
Customer inquiries are of basic and at times complex nature. Engages consults, and educates members based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources to help guide the members along a clear path to care.
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 members’ 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.
Job Description
CVS Health a Fortune 5 company is looking for a Client Support Representative. In this role you will be the first line of contact for our clients, setting the tone for how they view our company and services; while providing them with accurate information to help resolve any issues and/or concerns. The Client Support Representative works as a subject matter expert for the Anthem Client.
To be successful in this role you will be managing complaints, suggestions, and comments in queue.
You will receive and respond to client issues in a timely manner via email, fax, and telephone.
You will also be responsible for timely follow-up on requests to ensure resolution as well as ensuring complete tracking of client contact in the database to build contact history, identify trends, facilitate relationship building and provide management as well as client reporting. Other key responsibilities can include providing plan benefit override support at client request, providing feedback to Customer Care management on servicing incidents and developing service trends as well as partnering with the Account Management team to ensure maximum client satisfaction and issue trending. We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays. Our application process is 2 simple steps: 1. Apply online 2. Take our Online Virtual Job Tryout (Interview Platform) to learn even more about the position
Required Qualifications 1+ years of customer service experience 2+ years of health care industry experience
Job Description The Customer Service Representative is the face of Aetna and impacts members’ service experience by handling customer service inquiries and problems via telephone, internet, or written correspondence. Customer inquiries are of basic and at times complex nature. CSR engages, consults, and educates members based upon the member’s unique needs, preferences, and understanding while using tools and resources available to help guide the members along a clear path to care.
Required Qualifications Customer service experience in a transaction-based environment such as a call center or retail location.
Preferred Qualifications Trauma-informed care training Exposure to Care Management Experience in a production environment Familiarity with de-escalations 1-2 years of Healthcare or Medicaid experience Telework experience
Education High School Diploma or GED equivalent
Job Responsibilities: Initiates telephonic engagement with assigned members to introduce the program with the goal of enrolling the member in Aetna Care Management. Effectively meets daily metrics with speed, accuracy, and a positive attitude. The metrics are focused on unique members attempted daily and the volume of members that agree to enroll in care management. This is not a sales position, enrollment is free, but influencing is important to this work. Documentation is critical to success. The Engagement Specialist accurately and consistently document each call in the member's electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate Conducts triage, connecting members with appropriate care team personnel including care managers and customer service Demonstrates an outgoing, enthusiastic, and caring presence over the telephone. Works efficiently and independently, meeting deliverables and deadlines Adheres to care management, privacy and confidentiality, and quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures Demonstrates an ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm Other responsibilities as assigned
Required Qualifications Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records is preferred 2 years of experience preferably in customer service, telemarketing and/or sales Call center experience preferred Familiarity with basic medical terminology preferred Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am 8:00 pm Strong organizational skills, including effective verbal and written communications skills Bilingual (Spanish) preferred
In this dynamic and fast-paced role, you will be responsible to verify insurance coverage, performing benefit investigations, and obtaining prior authorization for both new and existing patients in order to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals, and insurance carriers. This role will require an understanding of insurance carriers and concepts including drug cards, major medical benefits, and per diem coverage as well as knowledge of government and patient assistance programs. This is a full-time benefited position and is NOT through an agency. Typical hours are Monday – Friday between 9:30 AM-6:00 PM CST. Colleague will be required to work mandatory overtime/extended workweek when needed, as well as, regular and predictable attendance. With Coram/CVS Health, you’ll have an exciting opportunity to utilize your healthcare and customer service experience with a team that is passionate about making a difference in patients’ lives. You can have an impact by providing the best care, education, and support to our patients, improving their overall quality of life! Coram/CVS Health is a Fortune 5 company and national leader in the home infusion and enteral nutrition fields. The word “Coram” derives from the Latin word “cor,” meaning “heart”… and our dedication to our customers is truly from the heart. Do you want to learn more? Check out the videos below! https://www.youtube.com/user/CoramHealthcare or https://www.youtube.com/user/CVSPharmacyVideos
Required Qualifications * Minimum year experience working in a customer service or call center environment. * Data entry experience. * Experience working in Microsoft Office, specifically Excel, Outlook, and Word.
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