Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. 2 candidates are needed in National Accounts.
Process accurate/timely eligibility data into Aetna, Inc. Foundation Systems to ensure production of National Account Member ID cards, electronic listings and audit reports. Correct adjudication of member/provider claims.
Utilize Aetna's Administration System (AAS) and Member Enrollment Application (MEA) to correctly enter eligibility transactions (enrollments, changes, terminations) via batch, online, or file upload facilities. Ensure eligibility transactions successfully interface downstream systems based on an understanding of each system's processing rules and interface limitations. Review enrollment forms, listings, or electronic file specifications to assess customer and vendor ability to adhere to Aetna, Inc. standards.
Resolve eligibility issues generated from the customers claim office. Respond to customer/vendor requests for information, problem resolution, or online transactions. Act as a consultant influencing decisions regarding customer and vendor eligibility submission processes.
Actively participate in new business installation meetings with Aetna, Inc. sales/service representatives and customer/vendor benefit and programming staff. Determine special programming needs as necessary. Follow up on file testing to ensure transmission of electronic eligibility can occur. Work closely with other team members to meet financial/data requirements.
Excel and Word experience required, Access experience a plus Excellent analytical skills. The ability to prioritize multiple urgent tasks; strong time-management skills Able to work well with all types of people.
Information management, data management, programming and documentation skills. Office support or data entry experience a plus. Successfully work in a fast paced environment. Excellent verbal communication
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
General Business/Communicating for Impact/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Service/Working Across Boundaries/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/MASTERY
Considered only for current internal teleworkers (in any area)
ADDITIONAL JOB INFORMATION
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, come work with us.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe.
We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail.
Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.