Terrific Contract Opportunity!
Come work for the nations premier health innovation company to join our mission of helping people on their path to better health. Be part of our innovative team that is unlocking the power of data to transform the healthcare experience.
Position: Bilingual Customer Service Representative
Location: Linthicum, MD, 21090
Term: 4 months (10/19/2020 to 02/28/2021)
Work Schedule: Mon-Fri 8:30a-5pm
- 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.
- 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 members 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.
Is this a good fit? (Requirements):
- Bilingual Spanish Outstanding written and oral communication skills Self-starter; capable of delivering goals with appropriate levels of coaching and supervision
- Excellent time management, decision-making, leadership collaboration and presentation skills
- Strength in multi-tasking and project prioritization
- Healthcare and/or insurance background a plus Proficient in Microsoft Office Suite
- High school diploma or GED required