This position is temporarily Work At Home due to COVID-19.
Aetna One Advocate is Aetna's premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors high-touch, high-tech member advocacy service which combines data-driven processes with the expertise of highly trained clinical and concierge member services. The mission of this model is designed to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members' needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health.
This is an exciting time to join Aetna a CVS Health company in our journey to change the way healthcare is delivered today. We are health care innovators!
Service Advocates engage members through personalized, premium and frequent touchpoints to deliver a simple, powerful, and proactive member experience, we call this Advocacy. Our specialized advocate teams address all members' needs - from benefits and network services to clinical and emotional support - all backed by local resources right in the member's community. In one simple word, we "Advocate" on behalf of our members. We own their healthcare journey and we won't stop until they are satisfied. Every interaction is handled with the utmost care, consideration and passion for the members we serve.
A portion of these position are reserved for candidates desiring to work 3pm
Consistently showcase a passion for health and helping people
Acts as a single-point-of-contact for the member. Explains member plan of benefits, member's rights and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.
Owns the members concerns all the way through to resolution no matter where that might take us. You will be interacting with providers, clinicians, pharmacists, and many other professional's in an effort to provide total satisfaction and resolution to the member.
Consistently seek to build trusting relationships with members by understanding their needs and health aspirations
Deliver a suite of services to members that support easy navigation of the healthcare system, from providing personalized next best action recommendations, to maintaining individual data accuracy and integrity
Assists the member in finding their health ambition
Connects the member with additional administrative and clinical resources as needed
Uses proactive, predictive and preventative analytics to service members
Provides high-quality, customer-focused telephonic service using knowledge of procedures and systems to meet and/or exceed customer satisfaction
Coordinates with clinicians to compile the member's Care Plan and conduct adherence follow-up
Works with case managers for members requiring urgent or emergent service, or services rendered in a setting other than a practitioner's office
This is an inbound and outbound call center position. Service Advocates are responsible for answering inbound calls regarding member's health care needs, while following up on commitments in a timely manner. Service Advocates will proactively make outbound calls to engage members and assist them along their health care Journey.
Handle sensitive member information with discretion
Prioritizes effectively to meet member service goals / deadlines
Resolves member issues, while effectively making the right decisions for our members
Collaborate with colleagues and co-workers to deliver a world class customer experience
Strong written & verbal communication skills required
Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment required
Demonstrated organizational and communication skills required
Intermediate typing skills
Ability to seamlessly, multi-task while using multiple systems, to efficiently provide service to members
Deep problem solving skills with demonstrated ownership of issue resolution
Possess top-notch people skills - listening, caring, connecting, empathy, and supporting
Highly perceptive individual with strong self-awareness and empathy in interacting with various audiences
Demonstrated propensity for responsiveness and a sense of urgency when helping members
Demonstrated ability to uphold Aetna's values of caring, inspiration, integrity, and excellence in each member interaction and in building team cohesiveness
Strong skillset in the use of the suite of Microsoft Office tools strongly desired
Ability to work effectively in a team environment required
Ability to learn and retain in a complex environment
Customer service experience preferred
High School Diploma or G.E.D required
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.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.