This position is temporarily Work At Home due to COVID-19. - This position will report to Chandler, AZ
*sign-on bonus for external AZ residents only*
Aetna One Advocate is Aetna's premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors high-touch, high-tech member advocacy service which combines data-driven processes with the expertise of highly trained clinical and concierge member services. The mission of this model is designed to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members' needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health.
Service Advocates engage members through personalized, premium and frequent touchpoints to deliver a simple, powerful, and proactive member experience, we call this Advocacy. Our specialized advocate teams address all members' needs – from benefits and network services to clinical and emotional support – all backed by local resources right in the member's community. In one simple word, we “Advocate” on behalf of our members. We own their healthcare journey and we won't stop until they are satisfied. Every interaction is handled with the utmost care, consideration and passion for the members we serve.
Consistently showcase a passion for health and helping people.
• Acts as a single-point-of-contact for the member. Explains member plan of benefits, member's rights and responsibilities in accordance with contracted arrangements, claim status information, benefit coverage, plan eligibility, dental, vision, pharmacy, HSA, provider details, care management, on-boarding, tool usage and available programs/resources.
• Owns the members concerns all the way through to resolution no matter where that might take us. You will be interacting with providers, clinicians, pharmacists, and many other professional's in an effort to provide total satisfaction and resolution to the member
• Consistently seek to build trusting relationships with members by understanding their needs and health aspirations
• Deliver a suite of services to members that support easy navigation of the healthcare system, from providing personalized next best action recommendations, to maintaining individual data accuracy and integrity
• Assists the member in finding their health ambition
• Connects the member with additional administrative and clinical resources as needed
• Uses proactive, predictive and preventative analytics to service members
• Provides high-quality, customer-focused telephonic service using knowledge of procedures and systems to meet and/or exceed customer satisfaction
• Coordinates with clinicians to compile the member's Care Plan and conduct adherence follow-up
• Works with case managers for members requiring urgent or emergent service, or services rendered in a setting other than a practitioner's office.
• This is an inbound and outbound call center position. Service Advocates are responsible for answering inbound calls regarding member's health care needs, while following up on commitments in a timely manner. Service Advocates will proactively make outbound calls to engage members and assist them along their health care Journey.
• Handle sensitive member information with discretion
• Prioritizes effectively to meet member service goals / deadlines
• Resolves member issues, while effectively making the right decisions for our members
• Collaborate with colleagues and co-workers to deliver a world class customer experience
Strong written & verbal communication skills required
• Ability to multi-task, prioritize and effectively adapt to a fast paced changing environment required
• Demonstrated organizational and communication skills required
• Intermediate typing skills – 50 WPM strongly desired
• Ability to seamlessly, multi-task while using multiple systems, to efficiently provide service to members
• Deep problem solving skills with demonstrated ownership of issue resolution
• Possess top-notch people skills – listening, caring, connecting, empathy, and supporting
• Highly perceptive individual with strong self-awareness and empathy in interacting with various audiences
• Demonstrated propensity for responsiveness and a sense of urgency when helping members
• Demonstrated ability to uphold Aetna's values of caring, inspiration, integrity, and excellence in each member interaction and in building team cohesiveness
• Strong skillset in the use of the suite of Microsoft Office tools strongly desired
• Ability to work effectively in a team environment required
• Ability to learn and retain in a complex environment
• Customer service experience preferred
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Please See Above
High School Diploma or G.E.D required
College Education Preferred
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.
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