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Life Claim Processor

Primary Location: Franklin, TN
Additional Locations: TN-Franklin
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Description:
Secure analyze and approve claim information to make recommendations for approval or denial of life claims. Lead Analyst for claim account management. Approval authority limit up to a maximum of $250,000.

Fundamental Components:
  • Manages/adjudicates a wide range of assigned Life and AD&D claims, (including adverse claims and complex AD&D) independently, seeking guidance and direction for more complex claims in accordance with the terms of the contracts.
  • Has responsibility for constituent satisfaction according to Aetna policies and practices.
  • Performs detailed analysis and documentation of claim data to direct effective outcome.
  • Coordinates investigations with consultant, interprets insurance contracts to determine Aetna's liability.
  • Determines claimant's eligibility and qualification for benefits and extent of dismemberment.
  • Interprets insurance contract to determine Aetna's liability.
  • Ensures compliance with contract provisions and state/federal regulations.
  • Effectively uses outside vendors to obtain information according to guidelines.
  • Independently prepares all claim denials with review from Consultant or Manager.
  • Makes accurate claim decisions in accordance with the terms of the contracts.
  • Responds to claim and account inquiries from claimants, policyholders and other interested parties and creatively resolves issues through effective verbal and written communication and by involving appropriate people within or outside Aetna.Contributes new ideas and concepts in a constantly changing environment.


Background Experience:
1 year as Life Trainee or equivalent related experience.
1-3 year experience Claim Processing
Bachelor's degree or equivalent industry experience.

Additional Job Information:
Strong math aptitude.Proven analytical ability.Strong verbal and written communication skills.

Clinical Licensure:
N/A

Potential Telework Position:
No

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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