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Claim Reporting and Special Services Consultant, Jacksonville, Florida

There is a lot of behind-the-scenes work that happens at Aetna to make sure customers and members have the experience they expect when they need health care. This includes making sure things run smoothly so doctors and providers can spend their time delivering care to our members, rather than dealing with a bureaucratic insurance company.

At Aetna, it's Cie Tinsley's job to work with our doctors and other health care professionals to ensure they know they are working with a company that cares about their time and interests. She proactively fixes provider issues before they become members' problems.

While reviewing numerous claims from a durable medical equipment provider, Tinsley noticed an unusual pattern that caused unnecessary delays in processing. Tinsley was determined to help resolve this issue. In doing some investigative work, she realized that the provider was using incorrect codes, causing the processing of the claims to take longer than necessary.

In a spirit of positive collaboration, Tinsley contacted the provider and explained how to accurately submit claims to ensure prompt processing and payment. As a result, this provider's claims are paid on time and accurately; and the provider is more satisfied with Aetna.

In taking these additional steps, Tinsley exemplifies the work of Aetna's provider team members - going above and beyond to help the constituents they serve. It's one of the main reasons Aetna has been named the preferred partner for hospitals and physicians by DAVIES in its National Payor Survey; which reveals a strong preference from hospital leaders to deal with Aetna based on trust, honesty, business practices and good-faith negotiations.   [Click here to read the transcript of this employee's story]

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