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Claim Benefit Specialist

Primary Location: San Antonio, TX
Additional Locations: TX-San Antonio
Reviews and adjudicates medical claims in accordance with claim processing guidelines. At Aetna, we are currently recruiting analytical, detail oriented and caring and curious claim processors who are willing to be problem solvers and champions for our members’ best health to help guide the members along a clear path to care. We work to build trust with our members and take pride in doing the right thing for the right reason. If you are passionate and empathetic about the people you serve and have a medical claim processing background with attention to detail and accuracy, this position may be a fantastic career opportunity for you!

Fundamental 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.
  • CBS 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.
  • CBS have knowledge of policy, procedure and resources to comply with regulatory guidelines

Background Experience:
  • To be successful, CBS require experience in a production environment and medical claim processing experience.
  • 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.
  • In addition to 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.

Additional Job Information:
Understanding of medical terminology.Oral and written communication skills.Ability to maintain accuracy and production standards.Technical skills.Attention to detail and accuracy.Analytical skills.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Demonstrating Business and Industry Acumen, Service - Handling Service Challenges, Service - Improving Constituent-Focused Processes

Desired Skills:
Service - Creating a Differentiated Service Experience, Service - Working Across Boundaries

Functional Skills:
Claim - Claim processing - Medical or Hospital - ACAS, Claim - Claims Administration - coordination of benefits (COB) verification

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Foundation Classes, Desktop Tool - Microsoft Outlook

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.

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 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.


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