Customer Srvc Rep - HCB Ops
Company: Aetna Inc.
Posted on: June 25, 2022
This is a 100% work from home opportunity
This position also includes a $1,000 sign on bonus to be paid after
30 days of training (Bonuses are only applicable to external
candidates in specific positions, locations, and business groups.
Applicable roles have the bonus language in the job posting).
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 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
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 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 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
Familiarity with Microsoft Office products
High speed internet access
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated
against COVID-19 (including any booster shots if required), where
allowable under the law, unless they are approved for a reasonable
accommodation based on disability, medical condition, religious
belief, or other legally recognized reasons that prevents them from
You are required to have received at least one COVID-19 shot prior
to your first day of employment and to provide proof of your
vaccination status or apply for a reasonable accommodation within
the first 10 days of your employment. Please note that in some
states and roles, you may be required to provide proof of full
vaccination or an approved reasonable accommodation before you can
begin to actively work.
Claims or high volume call center experience
High School diploma or GED equivalent.
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health. This purpose
guides our commitment to deliver enhanced human-centric health care
for a rapidly changing world. Anchored in our brand - with heart at
its center - our purpose sends a personal message that how we
deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone
who works at CVS Health to feel empowered by the role they play in
transforming our culture and accelerating our ability to innovate
and deliver solutions to make health care more personal, convenient
We strive to promote and sustain a culture of diversity, inclusion
and belonging every day.
CVS Health is an affirmative action employer, and is an equal
opportunity employer, as are the physician-owned businesses for
which CVS Health provides management services. We do not
discriminate in recruiting, hiring, promotion, or any other
personnel action based on race, ethnicity, color, national origin,
sex/gender, sexual orientation, gender identity or expression,
religion, age, disability, protected veteran status, or any other
characteristic protected by applicable federal, state, or local
Keywords: Aetna Inc., Austin , Customer Srvc Rep - HCB Ops, Other , Austin, Texas
Didn't find what you're looking for? Search again!