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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Claim Processor

Primary Location: Fresno, California
Additional Locations: CA-Fresno

Reviews and adjudicates routine claims in accordance with claim processing guidelines. Critical success factors - Ability to work independently - Ability to think logically and problem solve - Strong oral communication skills

Fundamental Components:

Analyzes and approves routine claims that cannot be auto adjudicated. Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. Routes and triages complex claims to Senior Claim Benefits Specialist. Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements

Background Experience:

Experience in a production environment. Medical claim processing experience preferred but not required. Medical coding background a plus but is not required.

Additional Job Information:

Understanding of medical terminology.
Oral and written communication skills.
Ability to maintain accuracy and production standards.
Technical skills.
Attention to detail and accuracy.
Analytical skills.

Opportunity to play a role
in an emerging and rapidly growing healthcare market. 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.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Desired Skills:
General Business - Consulting for Solutions, General Business - Maximizing Work Practices, Technology - Leveraging Technology

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

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. Click here to review the benefits associated with this 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.

Click To Review Our Benefits (PDF)


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