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. The CSR guides the member through their members
plan of benefits, Aetna policy and procedures as well as having knowledge
of resources to comply with any regulatory guidelines.
Creates an emotional connection with our members by understanding and
engaging the member to the fullest to champion for our members' best
Taking accountability to fully understand 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.
Customer Service experiences in a transaction based environment such as
a call center or retail location preferred, demonstrating ability to be
empathetic and compassionate.
Experience in a production environment
1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
Customer Service Representative is the face of Aetna and impacts
members' service experience by manner of how customer service inquiries
and problems via telephone, internet or written correspondence are
handled. Customer inquiries are of basic and at times complex nature.
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
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.
What days & hours will the person work in this position? List training hours, if different.
M t F 8:30 to 5