Customer Service Representative - Bilingual (Spanish)

Position Summary Customer Service Representative is the face of Aetna and impacts members' service experience by managing customer service inquiries and issues via telephone, internet, or written correspondence. Responsibilities Engage, consult and educate members based on their unique needs and preferences; guide them through Aetna plans, tools and resources. Answer questions and resolve issues from members, providers and plan sponsors. Triage rework to appropriate staff. Document and track contacts with members, providers and plan sponsors. Provide members with information to guide them toward care and create an emotional connection. Use the customer service threshold framework to make financial decisions that resolve member issues. Explain members' rights and responsibilities in accordance with the contract. Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances and appeals via the target system. Educate providers on self‑service options and assist with credentialing issues. Assist with legal document center requests and report preparation for complaints and claims audits. Determine medical necessity, coverage provisions and verify member plan eligibility for incoming correspondence. Handle appeals and pre‑authorizations not managed by Clinical Claim Management. Review member claim history to ensure accurate tracking of benefit maximums and coinsurance/deductible met. Maintain financial data as necessary and produce quality letters and spreadsheets in response to inquiries. Serve as an inbound brokerage call center representative, providing application, contract and appointment status. Required Qualifications Fluent in English and Spanish. Strong communication and empathy skills. Ability to navigate multiple systems and tools. Knowledge of health plan benefits and regulatory requirements. Preferred Qualifications Prior experience in healthcare, insurance or call center environments. Location in the Eastern Time Zone. Education High School Diploma or GED Anticipated Weekly Hours 40 Time Type Full time Pay Range $17.00 - $34.15 (base hourly rate or base annual full‑time salary) Training The training period is up to 10 weeks, 8 hours per day, Monday‑Friday. Time off requests are not approved during training. Permanent schedules begin as early as 8 am EST and end as late as 8 pm EST. Benefits This full‑time position is eligible for a comprehensive benefits package that includes medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources, based on eligibility. Legal and Equity Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement