• Eligibility Consultant

    AetnaPhoenix, AZ 85067

    Job #1100092717

  • Req ID: 67228BR

    Job Description

    Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data.

    Fundamental Components included but are not limited to:

    • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information

    • Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.

    • Monitors daily status reports assessing output for developing trends potentially impacting service levels.

    • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.

    • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.

    • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports).

    • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.

    • When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging.Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI).

    • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities

    • May include negotiating and communicating charges pertaining to non-standard services.

    • Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

    Qualifications Requirements and Preferences:

    • Medicaid Experience

    • Data Entry Experience

    • Attention to detail

    • Customer Service

    Functional Skills:

    Administration / Operation - Data Entry, Customer Service - Customer service - production environment

    Required Skills:

    General Business - Communicating for Impact, General Business - Turning Data into Information, Leadership - Collaborating for Results

    Desired Skills:

    Leadership - Creating Accountability, Service - Creating a Differentiated Service Experience, Service - Handling Service Challenges

    Additional Job Information:

    • Ability to analyze and research data to make appropriate corrections as necessary.

    • Understands the impact of work to other teams and downstream support areas.

    • Strong verbal and written communication skills.

    • Strong organization skills.

    • Problem solving skills.

    • Attention to detail and accuracy.

    Benefit Eligibility

    Benefit eligibility may vary by position.

    Job Function: Customer Service

    Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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