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Position Summary

A Health Concierge is the face of Aetna. They provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. The Health Concierge handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. They engage, consult and educate 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. Utilizing resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing is a key requirement of the job.

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 overcommitting.
Other activities may include: providing claim status information, benefit coverage View Job Posting Details 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, 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 overcommitting.
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,

The typical pay range for this role is: $17.00 - $29.30

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

Education
Equivalent work experience

Pay Range

The typical pay range for this role is:

$17.00 - $31.30

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/27/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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