Claims ProcessorPrimary Location: San Antonio, TX
Additional Locations: TX-San Antonio Apply
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 medial claim processing background with attention to detail and accuracy, this position may be a fantastic career opportunity for you
- Analyzes and approves routine 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.
- Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
- Routes and triages complex claims to Senior Claim Benefits Specialist.
- 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.
- May facilitate training when considered topic subject matter expert. 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).
- 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.
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