The Medicare Client Service team is looking for a mature professional with experience in working within a complex and fast paced organization. The Plan Sponsor Liaison will work onsite at the customer's location in Hartford, Connecticut. Also, we are looking for an individual who has the ability to perform root cause research and analysis to manage multiple inquires and recommended solutions. Candidates will be required to lead change, use strategic thinking, and collaborate with other departments to ensure all issues are resolved. Candidates must be able to provide examples of public speaking, prior analysis, root cause determination and recommended outcomes. Also, candidates should have strong customer service skills to coordinate concierge service delivery and member advocacy including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
• Customer Service - Plan Sponsor - Eligibility - HMO/1-3 Years
• Communications - Communication Delivery - Public Speaking/1-3 Years
• Claims – Medical Claim processing- Medicare/1-3 Years
Leadership/Collaborating for Results/ADVANCED
Service/Handling Service Challenges/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED
Fundamental Components/Job Description:
• Plan Sponsor Liaison for plan sponsors on member specific or broader plan administration matters
• Understands life cycle view of Medicare activities, quotes, install, eligibility, billing, administration, benefits, provider/network activity, claims (medical & RX), etc.
• Develops/implements a customer service strategy for each assigned Plan Sponsors/TPA's (customer fact sheets)
• Participates in implementation calls and site visits on plan sponsor's book of business serving as the Medicare Advantage subject matter expert (travel as needed)
• Identifies business problems, obtains information and accurately defines root causes while developing a course of action for successful service solutions
• Initiates and maintains partnerships with others within Aetna to encourage cooperation and cross-functional activities on workflow, ideas and service solutions
• Ownership and accountability for the resolution of the Plan Sponsors/TPA service inquires.
• Ownership of the Plan Sponsor Tool, ID card quality review, Archer as well as use service tools to provide detailed membership reporting to create a snapshot of the lifecycle.
• Work in tandem to monitor the submission of new business & renewal paperwork to ensure systems are updated & eligibility is processed in accordance to Open Enrollment timeline
• Provide updates on issue resolution and action plans to Plan Sponsor, TPA, Sales Executives and Medicare Client Services management
• Acknowledge receipt of escalated service inquiries to the plan sponsors/account team and resolve/respond in less than 1 business day, and for issues requiring a longer resolution, follow up at set intervals
• Takes a proactive role in all internal/external calls by being prepared and well versed in all subject matters related to PSL role & responsibility.
• PSL leads all back-office operation conversations, researches and responds to all operational takeaways.
• Articulates the CMS regulatory requirements that govern the Aetna Medicare Advantage Plans and demonstrate knowledge of understanding of all Aetna Medicare products and services.
Candidate should have a strong knowledge of Original Medicare guidelines/requirements & Aetna Medicare Advantage policies. The Plan Sponsor Liaison will be responsible for managing and maintaining their own book of business as candidates must be detailed oriented, organized, and proactive.
COVID-19 Vaccination Requirement
CVS Health requires certain 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
General Business/Turning Data into Information/ADVANCED
Service/Creating a Differentiated Service Experience/FOUNDATION
Service/Working Across Boundaries/ADVANCED
Bachelor's degree or equivalent experience
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