Claim Benefit SpecialistPrimary Location: Allentown, Pennsylvania
Additional Locations: PA-Allentown Apply
Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.
- Determine and understand the coverage provided under a member's health plan
- Efficiently use multiple systems and screens to obtain and record claim information
- Review claims information to determine the nature of a member's illness or injury
- Identify claim cost management opportunities and refer claims for follow up
- Make claim payment decisions * Process claims accurately to enhance customer satisfaction and retention
- Process claims within quality and production standards
- Assist team members in support of achieving team, office, regional, and national goals
Experience in a quality and production environment. Attention to detail. Ability to use multiple computer applications at one time. Claim processing experience.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Technical - Operating Systems/Windows/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
General Business/Maximizing Work Practices/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
General Business/Communicating for Impact/FOUNDATION
Service/Creating a Differentiated Service Experience/FOUNDATION
This is not a telework position.
ADDITIONAL JOB INFORMATION
We are looking for a detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics. The ideal candidate will have exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude. Prior medical claim processing experience is a plus. Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction. Comprehensive training will be provided to assist in the achievement of these objectives. Attendance during the 20 week training period is required. After completion of the training period, overtime may be required based on business needs.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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