Senior Service Advocate
Single Point of Contact for handling member service inquiries, issues, and education via telephone, internet, web-chat, email, written correspondence, walk-ins, and “on-boarding” programs.
Acts with fast knowledge using integrated service tools.
Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of the Consumer Business suite of services.
Provides end to end accountability for the member.
Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, letters, email, internet, chat, outreach programs, and walk-ins from members.
Provides information based on Consumer Business or business unit specific suite of services.
Explains member plan of benefits, member’s rights and responsibilities in accordance with contracts and contracted arrangements, claim status information, full range of benefit coverage, plan eligibility, premium payment and billing.
Builds a trusting relationship with the member by taking accountability to fully understand the member’s needs.
Walk members through programs, Aetna tools and resources to support better health care consumer behaviors.
Initiates out-reach/welcome calls during “on-boarding” to educate member of available tools, plan programs, on-line and mobile application, resources, etc.
Ability to resolve complex issues with sensitivity and discretion.
Takes ownership of each member contact to resolve their issues and connect them with additional services as appropriate.
Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes.
Uses communication skills to build relationships with both internal and external members/constituents.
Uses applicable system tools and resources to produce and/or quality letters and spreadsheets in response to inquiries received.
Handle multiple functions and/or multiple products while maintaining and/or exceeding performance standards.
Identifies issues that need to be escalated appropriately and offers suggestions for resolution.
Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents.
Supports individual, team and business goals and initiatives; accepts ownership for individual results.
Handles escalated calls and issues.
Assist with research and participate or lead special projects/initiatives addressing service issues and support of staff.
Demonstrates strong member focus and utilizes all available resources to ensure prompt member satisfaction within the department or engaging appropriate department.
Demonstrates functional expertise and leadership ability. Serves in a Lead role for team members and may act as a backup to supervisor,
Through in-depth analysis, identifies complaint trends and any emerging member service issues and works to develop solutions to address potential problems.