Job Description
This position also includes a $1000 sign-on bonus as well as an additional $2000 90 days post-training! 100% remote also the following locations:
Raleigh, NC, New Albany, OH, Pittsburgh, PA, Saint Paul, MN, Fresno, Harrisburg, PA Austin, TX New Albany, OH Jacksonville, FL., Tallahassee, FL, Atlanta, GA, High Point, NC. Fully remote
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
$1000 Sign-On Bonus
100% work-from-home opportunity!
$1,000 sign-on bonus PLUS a $2,000 bonus after 90 days of successful training!This
Reviews and adjudicates routine Medicare claims on HRP system in accordance with claim processing guidelines. Claims adjudication results should meet/exceed production and quality standards in line with CMS and Aetna compliance and business requirements. Analyzes and approves routine claims that cannot be auto adjudicated. • Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis, and pre-coding requirements. • May facilitate training when considered topic subject matter expert. • In accordance with prescribed operational guidelines, manages claims on the desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). • Utilizes all applicable system functions available ensuring accurate and timely claim processing
Required Qualifications Experience in a production environment Detail and quality-oriented Ability to research and work with several applications simultaneously Microsoft Outlook
Customer Service Representative - Raleigh, NC
Work from Home – $1,000 Sign-on Bonus
Job Description This position is permanent work from home for any candidate in the EST time zone. This position also includes a $1000 sign-on bonus as well as an additional $2000 90 days post-training! (Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting.) 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.
Required Qualifications 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 members' 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 report 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.
Work From Home- $1000 Sign-On Bonus
Description: Provides targeted, personalized service based on a holistic view of the member, benefits, health information, and engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence.
Engages consults, and educates members by delivering individualized programs based upon the member's unique needs and preferences.
Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost-sharing. Fundamental Components: – Answers questions and resolves issues as a single point of contact based on phone calls, plan sponsors, PSS/ISO, members, and providers.
– Provide customized interaction based on customer preference and individualized needs.
– Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with Aetna Navigator, Consultation Opportunities Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc).
– Utilizes all relevant information to effectively influence member engagement. – Proactively assesses customer issues and anticipates their needs. – Based on the issues and customer needs, quickly determine if the member call should be extended.
– Takes immediate action when confronted with a problem or made aware of a situation
Required Qualifications -Customer Service experiences are preferred, demonstrating the ability to be empathetic and compassionate. -Effective communication skills, both verbal and written -Effective organizational skills and ability to manage multiple tasks.
Work from Home -$1,000 Sign-on Bonus
Job Description • Provides targeted, personalized service based on a holistic view of the member, benefits, health information, and engagement. • Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. • Engages, consults, and educates members by delivering individualized programs based upon the member’s unique needs and preferences. • Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost-sharing.
Required Qualifications • Customer service experience • Ability to multitask and work in a fast-paced environment • Strong communication skills • Strong computer skills with the ability to use multiple systems at once
Preferred Qualifications Understanding of medical terminology
Education High school diploma, G.E.D., or equivalent experience.
Work From Home- $1000 Sign-On Bonus
Job Description
This position is permanent work from home for any candidate in the CST time zone.
This position also includes a $1000 sign-on bonus as well as an additional $2000 90 days post-training! (Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting.)
Required Qualifications
Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members, and providers.
Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
Fully understands 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.
Work from Home- $1,000 Sign-on Bonus
This position is permanent work from home for any candidate in the PST time zone.
This position also includes a $1000 sign-on bonus as well as an additional $2000 90 days post-training! (Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting.)
Required Qualifications
Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members, and providers.
Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
Fully understands 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.
Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).
Utilizes all relevant information to effectively influence member engagement.
Takes immediate action when confronted with a problem or made aware of a situation.
Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
Work from Home -$1,000 Sign-on Bonus
Job Description
This position is permanent work from home for any candidate in the EST time zone.
This position also includes a $1000 sign-on bonus as well as an additional $2000 90 days post-training! (Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting.)
Required Qualifications
Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members, and providers.
Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
Fully understands 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.
Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).
Utilizes all relevant information to effectively influence member engagement.
Takes immediate action when confronted with a problem or made aware of a situation.
Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
Work from Home- $1000 Sign-On Bonus
Job Description
This position is permanent work from home in any time zone.
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.
-Explains member’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.
Required Qualifications -Customer Service experiences in a transaction-based environment such as a call center or retail location, demonstrate the ability to be empathetic and compassionate.
-All employees are required to commute to the office when experiencing internet outages or any technical problem that prevents them from working remotely
-Aetna/CVS Health furnishes the work-at-home equipment and employees are responsible for purchasing a reliable internet connection at home with a minimum download speed of 25 Mbps and an upload speed of 3Mpbs or more
-It is a requirement that an ethernet cord is used while working from home. Wifi does not always provide a reliable connection.
Fully Remote $1000 sign-on bonus
Manage inbound call activity in a queue. -Initial review of tasks and other administrative-type activities that support the unit. Work hours after orientation 8:00-4:30 ET 3-day shifts, 1 evening shifts business unit closes at 11:00 pm the ET, the shift may vary to meet business need. Friday late rotating shift. No holidays or weekends.
Required Qualifications -The ideal candidate should have strong customer service skills -Effective communication, telephonic and organizational skills -Candidates will need effective time management, the ability to manage multiple priorities -Strong teamwork skills -Must possess strong computer and keyboarding skills.
Preferred Qualifications Knowledge of managed care 2-4 years experience in telephonic customer service preferred
Education High school diploma or G.E.D. required.
$1000 SIGN-ON BONUS
Required Qualifications
Effective communication, telephonic, and organization skills with the ability to be agile, manage multiple priorities at one time and adapt to change with enthusiasm.
Demonstrates ability to meet daily metrics with speed, accuracy, and a positive attitude.
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically.
Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Preferred Qualifications 2 – 4 years experience in the healthcare field (i.e. experienced in a medical office, hospital setting, medical billing/coding) preferred. Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records preferred. Familiarity with basic medical terminology and concepts used in care management is preferred. Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm. Strong organizational skills, including effective verbal and written communication skills. Bilingual (Spanish) preferred.
Education The highest level of education desired for candidates in this position is a High School diploma, G.E.D., or equivalent.
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