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Medical Claims Specialist

Primary Location: Rockville, MD
Additional Locations: MD-Rockville
Pursues the recovery of overpaid dollars that could involve the validation and allocation of more intermediate recoveries.

Fundamental Components:
Review provider contracts to confirm whether or not a claim is overpaid in order to allocate refund checks, for example unsolicited refunds. Performs basic (low to medium dollar, generally under $15,000) adjustments on customer service platforms. Balances and reconciles financial information with minimal guidance. Completes assigned projects/reports i.e. duplicate reports, retro termination reports, etc., Processes basic Provider Refund and Return Checks. Processes stop payment/void requests. Interfaces with customer by telephone and/or written correspondence to respond to inquiries and resolve concerns. Researches customer information by effectively using the available applicable resources within Aetna. Seeks out ways to continuously improve teaming by promoting a positive team environment. Understands the team’s performance against measured service operation goals; accepts ownership for individual and team results; identifies and initiates process improvements. Maintains quality goals and production. Performs other duties as required.

Background Experience:
Analytical and problem-solving skills.Previous (1 to 3 years) medical claims processing and adjustment experience preferred.Ability to interpret medical contract language preferred.Independent decision making skills.Displays a positive, confident attitude; highly self-motivated and accountable.Effective keyboard skills; able to navigate within a computer/systems-dependent environment without assistance; previous experience in a windows-based computer environment preferred.Customer service experience preferred.Effective communications, organizational, and interpersonal skills. High School Diploma or GED

Additional Job Information:
Analytical and complex claims processing skills with strong mathematical abilities.

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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