Fresno, California

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.
• 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.
• Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.
• Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.
• Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.
• Fully understands 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.
• 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.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.Identifies member needs beyond the initial inquiry by answering the unasked questions.
• Resolves issues without or with limited management intervention.
• Provides education to members to support them in managing their health.
• Responds quickly to meet customer needs and resolve problems while avoiding over-committing.
• Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.
• Processes 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.
• 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 post-enrollment member satisfaction.
• Partners with other departments to deliver client specific presentations.
• Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.
• Works collaboratively with colleagues to deliver the best customer experience
• Seeks to understand the customer, including circumstances, problems, expectations and needs Asks probing questions to identify the underlying customer needs
• Appropriately transitions conversations to explore possibilities for extending customer interactions
• Guides members to the appropriate health resource
• Offers alternatives where appropriate
• 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.
• Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.
• Delivers internal quality reviews.
• Provides appropriate support in third party audits when required.
• Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes

Required Qualifications
• 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 organizational skills and ability to manage multiple tasks.
• Effective communication skills, both verbal and written

Preferred Qualifications
• Please review required qualifications above

Education
• Associate's degree or equivalent work experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Fresno, California

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