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Eligibility Consultant - Paper

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Job Details
Job Order Number
Company Name
Physical Address

Newark, DE 19713
Job Description

Req ID: 65328BR

Job Description

DE based position supporting multiple health plans. The Enrollment Representative 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:

+ Attention to detail and accuracy.

+ Problem solving skills.

+ Strong organization skills.

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

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

+ Strong verbal and written communication skills.

Functional Skills:

Claim – Claims Administration – coordination of benefits (COB) verification, Customer Service – Customer Service – Plan Sponsor – Eligibility – HMO, Customer Service – Customer Service – Plan Sponsor – Enrollment – HMO

Required Skills:

General Business – Communicating for Impact, Leadership – Collaborating for Results, Service – Working Across Boundaries

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. Click here to review the benefits associated with this 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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