Senior Service Advocate / Member Advisor

We are building an exciting new clinical and member engagement program at Aetna. Aetna’s Next Best Action (NBA) initiative is a member-centric program, designed to help members across all life stages achieve their best health, in their own way. 

The Senior Service Advocate will be part of an outbound case management call team dedicated to NBAs. The Senior Service Advocate will be responsible for direct member outreach and engagement across a variety of topics, e.g., site of care recommendation, preventative screenings, and enrollment in tech-driven behavior change pilots. The Senior Service Advocate may further connect members to Clinical colleagues or other Case Management teams within Aetna, to support members’ comprehensive health needs. The role requires a highly energetic blend of salesperson, health care navigator and health plan customer support representative. 

This role is a unique opportunity to work closely with our Analytics and Behavior Change (AB&C) team. A&BC data scientists deploy innovative analytics techniques to identify members who would most benefit from telephonic outreach across a variety of health actions. They partner closely with the Aetna Operations teams to activate NBAs through this dedicated NBA team, synced with additional channels, e.g., email, direct mail, SMS, IVR, mobile, and social media. 

• Influences members towards adoption of healthy actions, such as, site of care recommendation, preventative screenings, and enrollment in tech-driven behavior change pilots, which results in behavior change (adoption) towards healthy outcomes.  

• Highly developed consultative selling skills – with a focus on high functioning verbal and written skills, excellent questioning techniques, and exceptional influencing skills (internal and external).   

• Place outbound calls to members for one-time campaigns, e.g., Flu season, non-par Lab visits, colonoscopy reminders; Demonstrates an outgoing, enthusiastic, and caring presence over the telephone. Goal to have meaningful and relevant conversations with each member to increases success of member behavior change towards healthy outcomes. 

• Effectively supports members during calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate. 

• Experience with technology-based interactions, including video, email, text, etc. and omni-channel “prospecting” campaigns strongly preferred. 

• Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs; Transfer relevant calls to clinical team mates to support members and address their clinical concerns. 

• Utilizes Aetna systems to build, research, and enter member information; performs non-medical research pertinent to the establishment, maintenance, and closure of open cases. 

• Accurately and consistently documents each call in the member’s electronic record, thoroughly completing required actions with a high level of detail.   

• Impact-oriented mindset, and enthusiasm working in a fast paced, Agile team environment, co-located in a Hub with Advocate colleagues and data scientists. 

• Effectively meets daily metrics with speed, accuracy, and a positive attitude with a focus on continuous improvement  

• Adheres to Compliance with PM Policies and Regulatory Standards. 

• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. 

• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records is preferred. 

• 2 years of experience preferably in customer service, telemarketing, inside sales, health coaching or B2B Sales. 

• Call center experience preferred. 

• Familiarity with basic medical terminology preferred. 

• Strong organizational skills, including effective verbal and written communications skills. 

• Bilingual language skills are a plus (e.g., Spanish, etc.)
• High School Diploma or G.E.D required. Associates/Bachelor’s preferred.