Job Title

Job DescriptionProcess accurate and timely eligibility into Aetna Systemsutilizing Aetna policy guidelines and in accordance with keyperformance measures and first claim/first call resolution.Provide Plan Sponsors with accurate bills and memberswith timely and accurate ID cards and audit cert lists.Improvement of financial results by reducing lossesassociated with non-payment. Ensures collected reconciled dollars are allocated across benefits and structure.Pay RangeThe typical pay range for this role is:Minimum: 17.00Maximum: 27.90Please 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.Required QualificationsReviews Plan Sponsor member listings, Plan Sponsor (orindividual member) payments, and/or terminations andcompares to actual billing statement to identify and resolve discrepancies. Monitors, researches, and resolves collection of outstanding premium or revenue adjustment issues and reports corrections to appropriate contact; Resolution activity related to delinquent accounts may involve verbal and/or written communications with customers and other key internal business areas.Ensures all manual adjustments, refunds, and write-offs are appropriately submitted, adhering to policy guidelines.Validates and updates Self Insured Revenue forecastinginformation and trends. Coordinates validation of eligibilityon fully insured and/or self-insured customers.Applies technical policy, legislation, Plan Sponsor accountstructure and benefit information to decisions.Codes rates and structure on new cases andrenewals/revisions, in system to provide customer withaccurate and timely invoices and to send data to downstream systems. Ensures that remittances are posted accurately across various benefits and account structure and reconciles customer remittances; Related activities may include Negotiating payment schedules and settlements. Identifies and determines appropriate treatment of overdue accounts and coordinates collection and cancellation of overdue customers in accordance with pre-established market segment process.Consults with internal/external customers to identifyaccurate account structure, billing format method andpayment arrangements to meet customer expectations.May serve or provide technical SME support to theteam/unit. Provides assistance and/or mentor internal andexternal constituents. Reviews Non-Admit reports to ensure that Plan Sponsor's balances are within statutory guidelines. Identifies electronic media prospects as it relates to premium payment back up and routinely contact and follow up with potential electronic candidates and finalizes electronic workflows with Plan Sponsor and/or vendor. Communicates and negotiates with Fortune 500 customers for prompt and accurate payment of amounts due. Researches, resolves and responds to eligibility and/or billing inquiries/member issues generated from Plan Sponsor, third party vendor, Member Services or marketing office. Answers questions and resolves issues based on phone calls/letters from Plan Sponsors and internal constituents.Preferred Qualifications5+ years Customer Service experience; Excel; Bookkeeping and analytical skillsEducationHigh School Diploma or work experienceBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.