This is a work from home opportunity for candidates located in CA, WA, NV and AZ.
At Aetna, we are currently recruiting caring, compassionate and curious Health Concierge Representatives who are willing to be problem solvers and champions for our members' best health to help guide the members along a clear path to care. We work to build trust with our members and take pride in doing the right thing for the right reason. If you are passionate and empathetic about the people you serve, this position may be a fantastic career opportunity for you!
The Health Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement.
• Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence.
• Engages, consults and educates members based upon the member's unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care.
• Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.
• Be a first line of contact with the customers.
• Work with members, providers and plan sponsors to help them understand our products and services.
• National Business Health Concierge's (HC's) create an emotional connection with our members by understanding and engaging the member to the fullest.
• HC's build a trusting relationship with the member by taking accountability to fully understand the members' needs.
• They identify member needs beyond the initial inquiry by answering the unasked questions.
• HC's answers questions and resolve issues as a ‘single-point-of-contact' based on phone calls, letters, emails, Internet, chat and outreach programs from members.
• They make financial decisions to resolve member issues using customer service threshold framework.
• They collaborate with colleagues and co-workers to deliver a world-class member experience.
• The HC guides and educates the member through various elements of their benefit plan information and available services created to enhance the overall customer service experience.
• HC's take ownership and resolve issues without or with limited management intervention.
• They have knowledge of Aetna policy, procedure and resources to comply with regulatory guidelines.
• National Business Health Concierges (HC's) - Answer questions and resolve issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.
• Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
• Fully understands 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.
• Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.). Utilizes all relevant information to effectively influence member engagement.
• Takes immediate action when confronted with a problem or made aware of a situation.
• Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.
• Identifies member needs beyond the initial inquiry by answering the unasked questions.
• Resolves issues without or with limited management intervention. Provides education to members to support them in managing their health.
• Responds quickly to meet customer needs and resolve problems while avoiding over-committing.
• Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.
• Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.
• Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.
• To be successful, a Health Concierge require strong ability to multitask, prioritize, problem solve and effectively adapt to a fast-paced, changing environment.
• In addition to excellent computer skills, top candidates will possess critical thinking, professionalism, strong listening and organizational skills and demonstrate empathy.
• A minimum of two years of Customer Service experience in a service environment, such as a call center or retail location preferred.
• Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
• Effective organizational skills and ability to manage multiple tasks.
• Effective communication skills, both verbal and written Associate's degree or equivalent work experience.
High School Diploma, G. E. D. or equivalent experience
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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