Member Service Representative (Bilingual Preferred)

About Our Company
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

JOB MISSION SUMMARY

Customer Service is the important first-line of contact with customers, setting the tone for how members, doctors and plan sponsor groups view our company. It provides members with the right information at the right time to help them make better decisions about their health and health care.

RESPONSIBILITIES
-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
-Explains member's rights and responsibilities in accordance with 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 credential 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
-Exhibits behaviors outlined in Customer Service Representative Competencies



Required Skills:
REQUIRED SKILLS
-High School diploma or equivalent is required; Bachelor's degree in business or related field is preferred
-Bilingual (Spanish)preferred
-One to two structured Customer Service training courses preferred
-Minimum of three (3) years of Customer Service experience, preferably in a fast paced environment
-Must possess excellent telephone skills
-Healthcare experience preferred
-Proficiency utilizing word processing and database software


Schaller Anderson is an affiliate of Aetna.  We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

To learn more about this opportunity, visit us at www.aetna.com/working 23827

Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.

We conduct pre-employment drug and background testing.
No agencies, please.


We are an equal opportunity/affirmative action employer.