About Us
We are a leading healthcare insurance company dedicated to providing innovative solutions to our members. Our mission is to deliver exceptional customer experiences, foster a culture of empathy and understanding, and empower our team members to make a meaningful impact in the lives of our customers. We are committed to creating a work environment that is inclusive, supportive, and stimulating, where our team members can grow and thrive.
About the Role
We are seeking an experienced Full Stack Customer Service Representative to join our team in New Jersey. As a key member of our customer service team, you will be responsible for delivering exceptional customer experiences, resolving complex issues, and providing personalized support to our members. This is a full-time, work-from-home opportunity with a competitive hourly rate of $26-$35 per hour.
Key Responsibilities
- Grow member and provider delight, retention, and growth by efficiently delivering competitive services to contributors and providers through a fully integrated enterprise staffed by informed, customer-focused specialists supported by exemplary technologies and methods.
- Engage, consult, and educate contributors primarily based on the member's unique needs, alternatives, and knowledge of Aetna plans, equipment, and sources to assist manual individuals along a clear route to care.
- Solve problems primarily based on smartphone calls/letters from members, carriers, and plan sponsors. Triages ensuing transform to suitable groups of workers.
- File and track contact with participants, carriers, and plan sponsors. The CSR guides the member through their member's plan of benefits, Aetna coverage, and approaches as well as having knowledge of assets to comply with any regulatory recommendations.
- Create an emotional connection with our contributors by way of knowledge and tasty the member to the fullest to champion our members' high-quality health.
- Take responsibility to absolutely recognize the member's needs by constructing a trusting and caring dating with the member.
- Anticipate patron wishes. Give the purchaser associated facts to reply to the unasked questions, e.g. extra plan information, advantage plan info, member self-carrier gear, and so forth.
- Use customer service threshold framework to make economic choices to resolve member issues.
- Explain member's rights and obligations by contract.
- Process declare referrals, new claim handoffs, nurse reviews, proceedings (member/issuer), criticism, and appeals (member/issuer) through the target machine.
- Educate carriers on our self-carrier alternatives; assist carriers with credentialing and re-credentialing issues.
- Respond to requests received from Aetna's regulation file middle regarding litigation; complaints.
- Handle great record assessment requests.
- Assist in training of grievance fashion reviews. Assist in compiling claim records for customer audits.
- Determine medical necessity and relevant coverage provisions and verify member plan eligibility regarding incoming correspondence and inner referrals.
- Handle incoming requests for appeals and pre-authorizations not treated by medical declare control.
- Play review of member claim history to make sure accurate tracking of benefit maximums and/or coinsurance/deductible.
- Play monetary facts renovation as vital.
- Make use of relevant gadget tools and resources to provide the best letters and spreadsheets in reaction to inquiries acquired.
Essential Qualifications
- Customer support stories in a transaction-based environment consisting of a name center.
- Experience in production surroundings.
Desired Qualifications
- Medicaid or fitness care enjoy.
Education
High faculty or GED equivalent.
About Our Work Environment
We offer a dynamic and supportive work environment that is designed to foster growth, learning, and collaboration. Our team members enjoy a range of benefits, including:
- A competitive hourly rate of $26-$35 per hour.
- A comprehensive benefits package, including medical, dental, and vision coverage.
- A 401(k) retirement plan with company match.
- A generous paid time off policy.
- A range of training and development opportunities.
- A dynamic and supportive team environment.
How to Apply
If you are a motivated and customer-focused individual who is passionate about delivering exceptional customer experiences, we encourage you to apply for this exciting opportunity. Please submit your application today and join our team in making a meaningful impact in the lives of our customers.
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