Job Description

Family Summary / Mission

The global operations team is responsible for delivering world-class service to our members, internal customers and providers. We are the face of Aetna and provide support, front line customer services, claims and product expertise.

We believe that a positive member experience starts with investment in our people. Our aim is to communicate with our customers on their terms, through local teams, in local languages. We want to know our customers, own our relationships with them, predict their needs and meet them proactively. We ensure our members get the healthcare they need, when they need it, with maximum value and minimum effort.

Position Summary/Mission

The Customer Service Consultant(MAT) role operates within our multi-channel Customer Centers to respond to customer requests and support customers with the administration of their insurance plan, enabling them to access healthcare anywhere in the world.

At Aetna, our leaders are naturally caring and empathetic, in addition to being keen problem solvers who take ownership of customer needs using their extensive knowledge, training,expertise and passion to navigate customers through their healthcare journey.

As a consultant (MAT) in the Customer Service team, you will use your experience and natural problem-solving skills to tackle more complex cases and be a point of escalation for other members of the team. This position requires a high level of responsibility.

You will enjoy developing your skills in a variety of ways, including:

· Professionally manage inbound & outbound telephone calls and email correspondence with customers, brokers, network providers, and all other interested parties ensuring that appropriate and timely communication is maintained.

· Complete eligibility verification, work closely with Clinical Case managers where appropriate, determine coverage, identify discrepancies, and apply cost containment measures, all whilst maintain a customer centric approach.

· Responsible for bringing Aetna International Medical management policies and procedures to life, in a customer centric fashion.

· Triage and prioritize caseloads considering urgency, geographical location, service required, and customer expectations.

· Take ownership for progression of caseloads and support colleagues in the management of their caseloads by providing clear advice and direction to remove barriers and delays.

· Working with your cross-functional peers with a constant view to improving the E2E member experience.

· Responsible for meeting Operational SLAs,customer satisfaction objections and key financial goals.

The Role:

As the Customer Service Consultant (MAT), you will;

· Have knowledge, skills and experience in a variety of Operational disciplines and processes, with knowledge of medical terminology, and medical case management.

· Display excellent oral and written communication skills.

· Demonstrate the importance of active listening and be able to role model professional and caring behaviors.

· Establish relationships with internal and external customers.

· Act proactively, take ownership of problems and be empowered to take actions to resolve our members concerns.

· Be resilient and adaptable. We work in a fast-paced environment with changing priorities, distressed customers, and at times high volumes of work and/or time sensitive deadlines. Our Employees must be able to thrive in this kind of environment.

· Make sound financial decisions in sometime urgent or ambiguous situations, putting the customer first whilst upholding and adhering to Aetna Internationals policies and procedures.

Responsibilities will include;

· Be a subject matter expert and a point of escalation for more complex queries.

Review and approve preauthorization requests in accordance with preauthorization process.

Handles customer service inquiries and problems via telephone, internet or written correspondence. Manage customer service inquiries and problems and respond to complex issues.

Acts as end-to-end contact for client's preauthorization journey and/or customer service problems.

· Play a leading role in the Regional team to ensure GOP and Enquiry volumes are turned around within SLA

· Explain plan benefits and relate them to the customer enquiry.

· Ensuring compliance with international and regional policies, practices and procedures.

· First line complaint resolution.

·

Background/Experience/Education

· Educated to A-level, secondary or pre-university level of education or higher. Equivalent Qualification and/or experience may be considered.

· Experience in an insurance and/or healthcare environment is essential. Clinical Qualification would be beneficial but not essential.

· Demonstrable success in a customer facing role for minimum of 2 years prior.

· Fluent written and spoken English with second language (Mandarin) being desirable.

· Previous Healthcare/Insurance/Supervisory Experience a plus.

Personal Attributes

You'll need to demonstrate the following:

· A passion for providing outstanding customer experience. Excellent listening skills.

· An ability to solve complex challenges. Self-motivation with an ability to work on your own initiative.

· Effective collaboration and team working. A high degree of accuracy and a keen eye for detail.

· High levels of organizational skills with the ability to prioritize and multitask.

· The desire to make things better. And the ability to ask questions or seek clarification if you need help or are unclear.

· Eager to work in a high energy, fast-paced business, where change is a constant.

Req#

60501BR

Job Group

Customer Service