Customer Service Representative

in Anchorage, AK

Customer Service Representative Job

Job Description Job Attributes+

  • Job ID

    989229

  • Req #

    73365BR

  • Job Location

    2525 C Street
    Anchorage, AK 99503, US

  • Job Category

    Aetna Better Health

  • Job Type

    Full Time

Job Description
Meritain Health's Call Center has multiple openings for Customer Service Representatives in our Anchorage, AK office. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

Fundamental Components

  • 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.
  • The CSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
  • Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
  • Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.Anticipates customer needs.
  • Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.Uses customer service threshold framework to make financial decisions to resolve member issues.
  • Explains member's rights and responsibilities in accordance with contract.
  • Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits.
  • Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits.Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
  • Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.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.



Background Experience

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



Additional Job Information
Ability to multi-task to accomplish workload efficiently.Understanding of medical terminology.Oral and written communication skills.Ability to maintain accuracy and production standards.Negotiation skills.Technical skills.Problem solving skills.Attention to detail and accuracy.Analytical skills.

Education
High School diploma, G.E.D. or equivalent experience

Percent of Travel Required
0 - 10%

Additional Information

Who We Are

We’re a values-based organization focused on helping people on their path to better health. Here, you’ll work alongside former members of the military and current reservists and members of the National Guard. Bring your unique skills to our industry, and we look forward to helping you grow your career.

We offer opportunities at all levels for U.S. Veterans and will enforce the Uniformed Service Employment and Reemployment Rights Act (USERRA).

Also, if you’re a Reservist member of the National Guard, be assured that you’ll have a job at CVS Health when you return from deployment. And, even though your civilian job may differ from your military job, we have many opportunities that may be right for you.

We recognize the value of military spouses bring to our company and continue to look for ways to help you find employment.

Explore our career areas and learn more about continuing your mission to help others.

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