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Associate Claim Benefit Specialist-Correspondence

Primary Location: Houston, Texas
Additional Locations: TX-Houston
Responsible for servicing customers by taking incoming paper claims and medical records and entering them into claims system, possibly paying them or routing correspondence to the appropriate internal business partner to meet or exceed expected turnaround times and compliance expectations.

Fundamental Components:
Processes paper claims and electronic work queues in accordance with company policies and procedures. Interprets and processes adjustments in accordance with company policies and procedures. Reviews basic pended claims to determine the appropriateness of the claim status. Researches customer information by effectively gathering documentation needed to process claims and adjustments and routes to appropriate department or queue. Examines information including, but not limited to, authorizations, payments, denials, coordination of benefits, and eligibility. Maintains production and claims quality standard. Takes responsibility for completing assignments and bringing all outstanding issues to closure. Maintains complete and accurate documentation. Demonstrates basic understanding of all products. Demonstrates responsiveness and a sense of urgency when dealing with customers. Proactively takes responsibility for own self-development. Demonstrates professionalism and presents a positive image of the company when interacting with customers. Supports individual and team goals and initiatives; accepts ownership for individual result. May interface with customers via telephone to respond to routine inquiries and resolve concerns on an as-needed basis. Performs other duties as required.

Background Experience:
Ability to absorb and apply new and changing information. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Effective verbal and written communication skills. Displays a positive, confident attitude; highly self-motivated and accountable. Strong listening and interpersonal skills; skilled at developing and maintaining effective working relationships. Responds positively to goal-setting and performance measurement. Effective keyboard skills; able to navigate within a computer/systems-dependent environment without assistance; previous experience in a windows-based computer environment preferred. Effective organizational skills and ability to manage multiple tasks. Demonstrated analytical and problem-solving skills. High School Diploma or equivalent.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Demonstrating Business and Industry Acumen, Service - Demonstrating Service Discipline

Functional Skills:
Administration / Operation - Data Entry

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

Click To Review Our Benefits (PDF)


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