Customer Service Representative

Aetna Inc. Fresno , CA 93707

Posted 2 months ago

Job Description:

Handles provider customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

  • Answers questions and resolves issues based on phone calls/letters from providers. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.

  • Explains member's benefits, rights and responsibilities in accordance with contract to our providers.

  • Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.

  • Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

  • Handles incoming status requests for appeals and pre-authorizations not handled by Clinical Claim Management .

  • Performs review of member/provider claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.

  • Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

Required Qualifications

1-2 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.

Preferred Qualifications

High volume call center experience

Medical Terminology

Education

Associates degree or equivalent work experience

Business Overview

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.

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Customer Service Representative

Aetna Inc.