Position: Client Services Specialist
Location: Princeton NJ 08540
Term: 4 months (05/24/2021 to 09/23/2021)
- Responsible for triage of mail, case classification and intake of appeals, complaints and grievances scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units.
- Ensure timely entry of appeals, complaints and grievance. May generate acknowledgment letters.
- Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business responsibilities.
- Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints and grievance criteria.
- Identify and research all components within member or provider/practitioner appeals, complaints and grievance for all products and services.
- Triage incomplete components of appeals, complaints and grievance to appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response.
- May Need to:
- Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial.
- Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process.
Is this a good fit? (Requirements):
- Ability to meet demands of a high paced environment with tight turnaround times.
- Ability to make appropriate decisions based upon Aetna's current policies/guidelines.
- Collaborative working relationships.
- High School or GED equivalent required
- Experience in reading or researching benefit language.
- 1-2 years experience that includes but is not limited too claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience.
- Experience in research and analysis of claim processing a plus.
- Some college preferred