French Speaking Case Management Associate - Member Assistance Team - Aetna Global Benefits ME LLC

Key Job Responsibilities:

• Effectively perform and document audit activities in accordance with professional standards and Aetna’s audit methodology.

• Working within the Member Assistance contact center, investigate, consider and pre-authorise treatment globally.

• Professionally manage inbound and outbound telephone, fax and email correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is maintained at all times.

• Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery.

• Triage and prioritise caseload considering urgency, geographical location and service level.

• Take ownership for progression of own caseload, maintain communication, remove barriers, avoid delays.

• Follow appropriate escalation process for high dollar claims.

• Investigate claims for possible abuse and fraud.

• May facilitate training and coaching when considered topic subject matter expert.

• Escalate unresolved claims complaints and high costs claims to Service Delivery Leader for guidance.

• Continually work to improve best practices procedures and standards.

• Ensure compliance with requirements of regional compliance authority/industry regulator.

• Adheres to international privacy policies, practices and procedures.

• Strives to deliver consistently excellent customer service internally and externally.

Job Details

Date Posted:	2015-02-26
Job Location:	Dubai, United Arab Emirates
Job Role:	Customer Service
Company Industry:	Healthcare, Practitioner and Technician

Preferred Candidate

Career Level:

Mid Career

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Date Posted: February 26, 2015 at 12:07PM

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French Speaking Case Management Associate - Member Assistance Team - Aetna Global Benefits ME LLC