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Aetna Service Center Team Lead in Chicago, Illinois

Req ID: 70707BR

Job Description

The Health Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement.

  • Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence.

  • Calls are typically non-routine and may require deviation from standard screens, scripts and procedures to engage, consult, and educate members by delivering individualized programs based upon the member s unique needs and preferences to help guide the members along a clear path to care.

  • Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.

  • Act as a subject matter expert by providing training, coaching and mentoring or responding to complex issues.

Fundamental Components included but are not limited to:

  • Answers questions and resolves issues as a “single-point-of-contact based on phone calls, letters and Webchat from brokers, marketing plan sponsors, PSS/ISO, members and providers.

  • Activities may include providing claim status information, benefit coverage interpretations and explaining plan eligibility. May include the disability intake queue.

  • Fully understand the member s needs by building a trusting and caring relationship with the member.

  • Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).

  • Utilizes all relevant information to effectively influence member engagement.

  • Serves as SME providing technical assistance when needed on call related issues, products and/or system applications delivery matters.

  • Coaches, trains and assists in the development of call center staff.

  • May participate and/or lead special projects/initiatives addressing service issues.

  • Multi-tasks to accomplish workload efficiently, assists others with best approach to workflows and resources (call handling, task lists).

  • Demonstrate ability to balance assignments independently.

  • Advanced ability to learn and accept new processes.

  • Pilots new processes when applicable.

  • Proactively assesses customer issues and anticipates their needs.

  • Based on the issues and customer needs, quickly determines if the member call should be extended.

  • Takes immediate action when confronted with a problem or made aware of a situation.

  • Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.

  • Resolves issues without or with limited management intervention.

  • Provides education to members to support them in managing their health.

  • Processing claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.

  • Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.

  • Through in-depth analysis, identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase 1 post-enrollment member satisfaction.

  • Partners with other departments to deliver client specific presentations.

  • Works collaboratively with colleagues to deliver the best customer experience:Guides members to the appropriate health resource.

  • Acts with the best interest of customer in mind and central to all interactions.

  • Collaborates with colleagues and co-workers to deliver a world class customer experience.

  • Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.

  • May participate in preparation and presentation of client specific presentations.

  • May track and trend data.

  • Coaches, trains and assists in the development of call center staff, as required.

  • Participates in and/or leads special projects/initiatives addressing service issues, as necessary.

  • Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

Qualifications Requirements and Preferences:

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

  • Effective verbal and written communication skills.

  • Effective organizational skills and ability to manage multiple tasks.

  • Demonstrated ability to handle multiple assignments and products(e.g. Aetna One, Disability) competently, accurately and efficiently.

  • Highly successful with all complex call categories including an understanding of multiple products (e.g. Aetna One, Disability), strong understanding of priorities, workflows and unit/team responsibilities.

Additional Job Information:

  • Innovative Thinking and “Change Agent - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.

  • Strong oral and written communication.

  • Strong analytical skills and innovative problem solving abilities.

  • Strong negotiation and collaboration skills.

  • In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other employee benefits), related financials, legal/regulatory requirements.

  • Empathy towards customers' needs and concerns.

  • Ability to maintain accuracy and production standards.

  • Technical skills.Attention to detail and accuracy.

Benefit Eligibility

Benefit eligibility may vary by position.

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.

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