Aetna Client Services Representative (ACA fronted employment) - 49775BR in Jakarta, Indonesia
Req ID: 49775BR
To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully-integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.
Handles customer service inquiries and problems via telephone, internet or written correspondence
Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)
• Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.
• Explains member's rights and responsibilities in accordance with contract.
• Processes referrals to the Claim and IHAT teams for claim referrals, new claim handoffs, pre-certifications and clinical reviews.
• Handle complaints (member/provider), grievance and appeals (member/provider) via relevant recording/reporting system (new system to be introduced 2010).
• Responds to requests received from Law Document Center regarding litigation/lawsuits.
• Ensures compliance with requirements of regional compliance authority/industry regulator.
• Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
• Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/ deductible. Performs financial data maintenance as necessary.
• Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
• May provide lists of in-network providers and facilities upon request.
• Adheres to international privacy policies, practices and procedures.
• Exhibits the following Employee Behaviors
• Experience in a production environment.
• Customer Service experiences in a transaction based environment such as a call center or retail location preferred.
• Experience in the Insurance or Financial Services industry desirable.
High School graduate or local market equivalent.
Additional Information (situational competencies, skills, work location requirements, etc.)
• Analytical skills.
• Ability to maintain accuracy and production standards.
• Technical skills.
• Oral and written communication skills.
• Understanding of medical terminology.
• Problem solving skills.
• Attention to detail and accuracy.
• Negotiation skills.
Job Function: Customer Service