Customer Service Rep

Aetna - Houston, TX
Handles Provider Service inquiries and problems via telephone, internet or written correspondence. This would include claims status, benefits and eligibility assistance as needed.

Fundamental Components:
Answers questions and resolves claim /contract related issues based on phone calls/letters from providers and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts.
Assists providers with claim inquiries, benefits and eligibility status
Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
Performs review of claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Uses applicable system tools and resources to service the caller with one call resolution in mind
Identifies issues that need to be escalated appropriately and offers suggestions for resolution.
Supports individual, team and business goals and initiatives; accepts ownership for individual results.
Takes ownership of each provider contact to resolve their issues and connect them with additional services as appropriate.
Creates an emotional connection with our providers by understanding and engaging with them to the fullest to champion for our members' best outcome.

CS experience in a production environment.
Ability to multi-task to accomplish workload efficiently.
Analytical skills.

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

Functional - Customer Service/Customer service - production environment/1-3 Years

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Service/Demonstrating Service Discipline/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION


a Differentiated Service Experience/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Working Across Boundaries/ADVANCED

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Attention - In the recruitment process, legitimate companies never withdraw fees from candidates. If there are companies that attract interview fees, tests, ticket reservations, etc. it is better to avoid it because there are indications of fraud. If you see something suspicious please contact us: [email protected]