Customer Service Representative

Customer Service Representative

Requirements

• Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
• Must live in Pacific Standard Time Zone including- California, Nevada, Washington, Oregon, and Idaho (Panhandle or North Idaho: Benewah County).

Responsibilities

• 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.
• 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.
• Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

Preferred Qualifications

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