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Claim Benefit Specialist

Primary Location: Bethlehem, PA
Additional Locations: PA-Bethlehem
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.

Fundamental Components:
  • 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

Background Experience:
Experience in a quality and production environment.
Attention to detail.
Ability to use multiple computer applications at one time.
Claim processing experience (preferred but not required).

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.

Required Skills:
General Business - Maximizing Work Practices, Service - Demonstrating Service Discipline, Technology - Leveraging Technology

Desired Skills:
General Business - Communicating for Impact, Service - Creating a Differentiated Service Experience

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Operating System - Windows

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate'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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