Aetna Int - Dubai

Job Group Summary
Customer Service is the important first-line of contact with customers,setting the tone for how members, doctors and plan sponsor groups view our company. It provides members with the right information at the right time to help them make better decisions about their health and health care.

Family Summary
To increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes

Position Summary
This position demands a high level of responsibility; you will be expected to act with autonomy, demonstrating the highest professional standards in a challenging yet highly rewarding environment.
You will provide operational and logistical support to our Clinical Case Managers, working in partnership to coordinate
the delivery of medical evacuation and healthcare services.
You will rapidly investigate, review and adjudicate claims, taking a proactive, highly professional and customer centered approach.

Fundamental Components
  • Attend/ participate in internal and external meetings relating to regional plans
  • Acts as a single-point-of-contact for escalated member-specific issues and/or broader plan administration matters
  • Implements bordereau control processes, ensuring accuracy and timeliness of the four way process involving Warba and ACAS teams. Review and enhance the process as required.
  • Deliver support to internal teams – MST Manila and Dubai, HGS India, and MAT/IHAT globally
  • Proactively identify and surface customer and plan issues for resolution while acting as a liaison to communicate workflow results, ideas and solutions.
  • Proactively resolve issues with account executives, sales representatives, installation managers and the claims office as appropriate.
  • Manage escalated customer issues
  • Provide quality assurance checks on the assessment of claims on Warba/ACAS bordereaux, and the quality of upload by HGS India.
  • Provide quality assurance checks on the MST Dubai team call handling, providing feedback and coaching where appropriate to improve delivery to the customer
  • Lead on planning and execution of quality calibration meetings with Warba and ACAS to ensure that all parties have consistency in the interpretation of the TOB and in the assessment of claims.
  • Coordinate/handle ad hoc account manager (AM) request
  • Proactively analyzes constituent data, identifies trends and issues and recommending remedial actions
  • Identifies most urgent business problems, obtains necessary information, accurately identifies root causes and generates solutions
  • Initiates and maintains partnerships with others throughout the organization.
  • Encourages cooperation by promoting common goals and building trust. Inspires, supports, and initiates cross-functional activities.

Background Experience Desired
  • Previous experience in a Clinical or Medical Assistance Environment highly
  • desirable.
  • Clinical background a plus.
  • Healthcare insurance industry experience.
  • Proven customer experience in a contact center environment.
  • Related supervisory experience preferred.

Additional Information
  • Candidates should be prepared to work some bank holidays according to the shift rotation (appropriate compensation is provided) since our team operates 24hrs a day, 7 days a week, 365 days a year.
  • Ability to work shifts operating between 19:30 – 07:30 on a 4 days/nights on / 4 days/nights off rotating shift basis.
  • Good communication skills with strong organizational and problem solving