Remote Member Services Representative Healthcare

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The Opportunity

Aetna is seeking a compassionate and knowledgeable Remote Member Services Representative to be the voice of our health plan for members across the country. In this role, you will handle a wide range of inbound contacts from Aetna members who have questions about their health, dental, and vision benefits, claims, and provider access. You will be trained extensively on Aetna's product portfolio and internal systems so that you can deliver accurate, empathetic, and efficient service that earns member trust and drives satisfaction scores.

Your Day-to-Day

  • Answer inbound calls and digital messages from Aetna members regarding benefits, claims, provider networks, and prior authorizations
  • Explain health plan terms such as deductibles, copayments, coinsurance, out-of-pocket maximums, and formularies in clear, accessible language
  • Assist members with finding in-network providers, specialists, and ancillary services
  • Research and resolve claim status inquiries, denials, and billing disputes in a single interaction where possible
  • Process address changes, ID card requests, and plan enrollment updates as directed by members
  • Document all member interactions accurately in Aetna's CRM platform
  • Maintain compliance with CMS, state-specific, and Aetna regulatory standards on every call

Who You Are

  • You have 1+ years of experience in customer service, with healthcare or insurance experience strongly preferred
  • You have a working knowledge of health plan terminology and managed care concepts
  • You are patient, empathetic, and skilled at communicating clearly with members of all backgrounds
  • You are comfortable navigating multiple computer systems simultaneously during live calls
  • You have a quiet, dedicated home workspace with reliable high-speed internet
  • High school diploma or equivalent required; some college education preferred

Benefits & Perks

  • Paid training program covering Aetna products, systems, and compliance requirements
  • Medical, dental, and vision insurance available from day one of employment
  • Flexible scheduling with full-time and part-time options available
  • Employee wellness programs and access to Aetna's EAP services
  • Monthly performance bonuses for quality and satisfaction benchmarks
  • Growth opportunities into senior service, claims, and care management roles
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1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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