Aetna Insurance Jobs – Eligibility Consultant

Job Description:

The Enrollment Representative position will be supporting multiple health plans. 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.

Job Responsibilities:

• 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

Job Requirements:

• Knowledge of Health Care and/or MCO’s.
• Understands the impact of work to other teams and downstream support areas.
• Attention to detail and accuracy.
• Problem solving skills.
• Workplace flexibility – ability to adapt to change
• Knowledge Medicaid and/or Medicare.
• Strong organization skills.
• Ability to analyze and research data to make appropriate corrections as necessary.
• Strong verbal and written communication skills.
• Knowledge and comfortability with learning different systems and using Excel
• High School Diploma, G.E.D or equivalent experience
• Knowledge of Enrollment.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Dover, DE, US

Application Deadline: N/A

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