Aetna Eligibility Consultant-Electronic in Blue Bell, Pennsylvania

Req ID: 53624BR

POSITION SUMMARY

Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Administers Group Eligibility in accordance with Medicare Advantage plans. Maintains enrollment databases and coordinates electronic transfer of eligibility data.

Fundamental Components:

  • Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients/vendors, sales and other assigned account team members to achieve positive service outcomes.

  • Applies Centers for Medicare & Medicaid Services guidance and Aetna policies associated with technical requirements and account structure in addressing eligibility matters.

  • Works electronic enrollment files and provides discrepancy reports to clients/vendors. Responsible for reconciling files between Aetna and clients/vendors.

  • Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.

  • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. Completes electronic enrollment files in 72 hours or less and acknowledges urgent items within 24 hours.

  • Ensures that Centers for Medicare & Medicaid Services compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.

  • Ensures all communications with clients/vendors involving sensitive member data adhere to CMS compliance requirements.

  • Exhibits the following Eligibility Cnslt - Electronic Behaviors

BACKGROUND/EXPERIENCE desired:

  • Candidate should have a strong command of Federal Medicare guidelines/requirements & Aetna Medicare Advantage policy.

  • 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

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

Telework Specifications:

Considered only for current internal teleworkers (in any area)

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.

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.

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.