Job Description

• 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.
• Calls are typically non-routine and may require deviation from standard screens, scripts and procedures to engage, consult, and educate members by delivering individualized programs based upon the member’s unique needs and preferences 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.
• Act as a subject matter expert by providing training, coaching and mentoring or responding to complex issues.

Fundamental Components

• Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, letters and Webchat from brokers, marketing plan sponsors, PSS/ISO, members and providers.
• Activities may include providing claim status information, benefit coverage interpretations and explaining plan eligibility. May include the disability intake queue.
• Fully understand the member’s needs by building a trusting and caring relationship with the member.
• 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.
• Serves as SME providing technical assistance when needed on call related issues, products and/or system applications delivery matters.
• Coaches, trains and assists in the development of call center staff.
• May participate and/or lead special projects/initiatives addressing service issues.
• Multi-tasks to accomplish workload efficiently, assists others with best approach to workflows and resources (call handling, task lists).
• Demonstrate ability to balance assignments independently.
• Advanced ability to learn and accept new processes.
• Pilots new processes when applicable.
• Proactively assesses customer issues and anticipates their needs.
• Based on the issues and customer needs, quickly determines if the member call should be extended.
• 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.
• Resolves issues without or with limited management intervention.
• Provides education to members to support them in managing their health.
• Processing 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.
• Through in-depth analysis, identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase 1 post-enrollment member satisfaction.
• Partners with other departments to deliver client specific presentations.
• Works collaboratively with colleagues to deliver the best customer experience: Guides members to the appropriate health resource.
• Acts with the best interest of customer in mind and central to all interactions.
• Collaborates with colleagues and co-workers to deliver a world class customer experience.
• Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.
• May participate in preparation and presentation of client specific presentations.
• May track and trend data.Coaches, trains and assists in the development of call center staff, as required.
• Participates in and/or leads special projects/initiatives addressing service issues, as necessary.
• Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

Background Experience

• 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 verbal and written communication skills.
• Effective organizational skills and ability to manage multiple tasks.
• Demonstrated ability to handle multiple assignments and products(e.g. Aetna One, Disability) competently, accurately and efficiently.
• Highly successful with all complex call categories including an understanding of multiple products (e.g. Aetna One, Disability), strong understanding of priorities, workflows and unit/team responsibilities.
• Associate's degree or equivalent work experience.

Additional Job Information

• Innovative Thinking and “Change Agent” - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.
• Strong oral and written communication.
• Strong analytical skills and innovative problem solving abilities.
• Strong negotiation and collaboration skills.
• In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other employee benefits), related financials, legal/regulatory requirements.Empathy towards customers' needs and concerns.
• Ability to maintain accuracy and production standards.
• Technical skills.
• Attention to detail and accuracy.