• DSNP Member Support

    AetnaBethlehem, PA 18020

    Job #1050855670

  • Req ID: 65994BR

    Job Description

    The Health Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement.

    • Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence.

    • Calls are typically non-routine and may require deviation from standard screens, scripts and procedures to engage, consult, and educate members by delivering individualized programs based upon the member s unique needs and preferences to help guide the members along a clear path to care.

    • Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.

    • Act as a subject matter expert by providing training, coaching and mentoring or responding to complex issues.

    Fundamental Components included but are not limited to:

    • Answers questions and resolves issues as a "single-point-of-contact based on phone calls, letters and Webchat from brokers, marketing plan sponsors, PSS/ISO, members and providers.

    • Activities may include providing claim status information, benefit coverage interpretations and explaining plan eligibility.

    • May include the disability intake queue.

    • Fully understand the member s needs by building a trusting and caring relationship with the member.

    • 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. Serves as SME providing technical assistance when needed on call related issues, products and/or system applications delivery matters.

    • Coaches, trains and assists in the development of call center staff. May participate and/or lead special projects/initiatives addressing service issues.

    • Multi-tasks to accomplish workload efficiently, assists others with best approach to workflows and resources (call handling, task lists).

    • Demonstrate ability to balance assignments independently.

    • Advanced ability to learn and accept new processes.

    • Pilots new processes when applicable.

    • Proactively assesses customer issues and anticipates their needs.

    • Based on the issues and customer needs, quickly determines if the member call should be extended.

    • 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.

    • Resolves issues without or with limited management intervention.

    • Provides education to members to support them in managing their health.

    • Processing claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.

    • Through in-depth analysis, identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase 1 post-enrollment member satisfaction.

    • Partners with other departments to deliver client specific presentations.

    • Works collaboratively with colleagues to deliver the best customer experience.

    • Guides members to the appropriate health resource.

    • Acts with the best interest of customer in mind and central to all interactions.

    • Collaborates with colleagues and co-workers to deliver a world class customer experience.

    • Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.

    • May participate in preparation and presentation of client specific presentations.

    • May track and trend data.Coaches, trains and assists in the development of call center staff, as required.

    • Participates in and/or leads special projects/initiatives addressing service issues, as necessary.

    • Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

    Qualifications Requirements and Preferences:

    • Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.

    • Effective verbal and written communication skills.

    • Effective organizational skills and ability to manage multiple tasks.

    • Demonstrated ability to handle multiple assignments and products (e.g. Aetna One, Disability) competently, accurately and efficiently.

    • Highly successful with all complex call categories including an understanding of multiple products (e.g. Aetna One, Disability), strong understanding of priorities, workflows and unit/team responsibilities.

    • Associate's degree or equivalent work experience.

    Additional Job Information:

    • Innovative Thinking and "Change Agent - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.

    • Strong oral and written communication.

    • Strong analytical skills and innovative problem solving abilities.

    • Strong negotiation and collaboration ~~~-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other employee benefits), related financials, legal/regulatory requirements.

    • Empathy towards customers' needs and concerns.

    • Ability to maintain accuracy and production standards.

    • Technical skills.Attention to detail and accuracy.

    Benefit Eligibility

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Job Function: Customer Service

    Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.