Req ID: 31640BR
POSITION SUMMARY
This is an in office based position supporting multiple health plans. This role is a fast paced production driven position (not a call center role), where you will multi-task, learn and have room for growth! The Enrollment Representative under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. You will maintain enrollment databases and coordinate transfer of non-electronic eligibility data.
This role is in office only (located in Newark, DE)
Fundamental Components
* Responds, researches, and resolves eligibility and/or billing related issues involving member specific information
* Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
* Monitors daily status reports assessing output for developing trends potentially impacting service levels.
* Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
* Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
* Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
* Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
* When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.
* Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).
* Determines and communicates standard service charges to internal/external customers related to paper eligibility activities May include negotiating and communicating charges pertaining to non-standard services.
* Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
* Responds, researches, and resolves eligibility and/or billing related issues involving member specific information
* Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
* Monitors daily status reports assessing output for developing trends potentially impacting service levels.
* Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
* Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
* Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).
* Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
* When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.
* Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).
* Determines and communicates standard service charges to internal/external customers related to paper eligibility activities May include negotiating and communicating charges pertaining to non-standard services.
* Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.
BACKGROUND/EXPERIENCE
* Attention to detail and accuracy.
* Problem solving skills.
* Strong organization skills.
* Understands the impact of work to other teams and downstream support areas.
* Ability to analyze and research data to make appropriate corrections as necessary.
* Strong verbal and written communication skills.
* Strong typing/keyboarding skills
* Healthcare experience preferred!
* Excellent computer skills a must!
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Customer Service/Customer Service - Plan Sponsor - Eligibility - HMO/1-3 Years
Functional - Claims/Claims Administration - coordination of benefits (COB) verification/1-3 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Enrollment - HMO/1-3 Years
REQUIRED SKILLS
General Business/Communicating for Impact/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
Service/Working Across Boundaries/ADVANCED
DESIRED SKILLS
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED
ADDITIONAL JOB INFORMATION
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.
Job Function: Customer Service