Claim ProcessorPrimary Location: Fresno, California
Additional Locations: CA-Fresno Apply
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
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
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.
Attention to detail and accuracy.
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.
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