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Aetna Health Survey Specialist / Service Advocate - Work At Home in Ft Wayne, Indiana

Req ID: 72514BR

Job Description

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary

The Health Survey Specialist plays a critical role within the DSNP team. The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the member s Individualized Care Plan and sets the foundation for follow up care management by assessing a member s medical, functional, cognitive, psychosocial, and mental health needs.

Fundamental Components included but are not limited to:

Fundamental Components

  • Uses motivational interviewing and other consultative techniques to gather comprehensive information about a member s medical, functional, cognitive, psychosocial, and mental health needs

  • Accountable to the highest level of compliance integrity

  • Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNP s interdisciplinary care team and customer service

  • Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment

  • Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment

  • Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate

  • Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed

  • Accurately and consistently documents each call in the member s electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements

  • Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA

  • Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm

  • Determined to build strong relationships with peers and our DSNP members

  • Demonstrates an outgoing, enthusiastic, and caring presence over the telephone

Qualifications Requirements and Preferences:

Background Experience

  • At least 3 years of experience in health care, customer service, telemarketing and/or sales

  • Familiarity with basic medical terminology, health care, and the concepts of care management

  • Medicare/Medicaid/DSNP experience preferred

  • Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required

  • Strong organizational skills, including effective verbal and written communications skills required

  • Data entry and documentation within member records is strongly preferred

  • Flexibility with work schedule to meet business needs

  • Bilingual desired

Education and Certification Requirements

  • High School diploma or G.E.D. required

  • Associates/Bachelor s degree preferred

Additional Job Information:

Strong communications skills.Strong analytical skills focusing on accuracy and attention to detail.Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.Understanding of medical terminology.Ability to maintain accuracy and production standards.Negotiation skills.Problem solving skills.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Customer Service

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.