Medical Claim ProcessorPrimary Location: High Point, NC
Additional Locations: NC-High Point Apply
62977Fundamental Components: Claim Benefit Specialist (CBS). CBS build a trusting relationship with the member by analyzing and processing claims accurately and timely in accordance with prescribed operational claim processing guidelines. They take accountability to fully understand the members’ benefit coverage, complete eligibility verification, identify discrepancies and apply all cost containment measures. CBS coordinates responses for routine phone inquiries and written correspondence related to claim processing. They have knowledge of policy, procedure and resources to comply with regulatory guidelines.
- Analyzes and approves claims that cannot be auto adjudicated.
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
- 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.
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
- Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools).
- Strong analytical and technical skill with ability to maintain accuracy and production standards.
- Understanding of medical terminology with strong attention to detail and accuracy.
- Ability to multitask, prioritize, problem-solve and effectively adapt to a fast-paced, changing environment.
- Excellent written, oral communication and computer skills.
- Top candidates will possess critical thinking, technical skills, professionalism and understanding of medical terminology with prior medical claim processing experience preferred.
- Ability to use multiple computer applications at one time.
Our Claim Processors are very important first line of contact with the customers. Our claim processing team consists of talented, dedicated people with the skills to make a difference in the lives of our customers. The setting is fast-paced, and customer satisfaction is a top priority. People who thrive in our organization can handle multiple tasks while maintaining positive and professional outlook. Our work environment is engaging and diverse. Employees are encouraged to satisfy professional ambitions, take pride in their contributions and share in our success.
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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.