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

Claim Benefit Specialist

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix
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Description:
POSITION SUMMARY
Review and conduct initial medical processing and rework on sensitive, and/or specialized claims in accordance with claim processing guidelines. Acts as a subject matter expert on root cause and analysis, presenting process improvement opportunity, resulting in an enhanced member experience.

EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES
Functional - Claims//1-3 Years

ADDITIONAL JOB INFORMATION

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates'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.


Fundamental Components:
Fundamental Components:
Reviews requests for initial medical processing and rework to identify accuracy of request.
-Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the accuracy of the rework adjudication process.
-Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures.
-Identifies and reports possible claim over-payments.
-Performs claim re-work calculations.
-May be required to distribute work assignments daily to staff.
-Trains and mentors team members.
-Makes outbound calls to obtain required information needed to complete a re-consideration.




Background Experience:
BACKGROUND/EXPERIENCE desired:
Experience in a production environment.
Claim processing experience.
Strong analytical and critical thinking skills

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. Click here to review the benefits associated with this position.

Candidate Privacy Information:
N/A

Click To Review Our Benefits (PDF)

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