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Aetna is now a CVS Health Company

Medicare Claim Benefit Specialist

Primary Location: Sandy, UT
Additional Locations: UT-Sandy
Aetna's mission is to build a healthier world by helping people realize their ambitions and achieve their goals, one person and one community at a time. At Aetna, we're highly aware of the value that diversity brings to our business and how an inclusive environment has the power to create new opportunities in the marketplace.

Aetna's Medicare Service Operations is expanding and growing in Sandy, UT! Come join a exciting organization offering Full Time Employment and all the perks of working for a Fortune 3 Company: Full Benefits (Medical, Dental, Vision), 401k, PTO, Tuition Reimbursement and much more!

Aetna is hiring 25 Medicare Claims Processors to support our growing organization. Our Claims Processors will review and adjudicate routine and complex Medicare claims in accordance with claim processing guidelines.

All Claims Processors will be office based in our Sandy location at: 10150 South Centennial Parkway, Sandy, UT 84070

Fundamental Components:
(*) Analyzes and approves routine and complex Medicare 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.
(*) 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).

Background Experience:
Experience in a production environment. Claim processing experience. High School or GED equivalent.

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 - Turning Data into Information, Service - Demonstrating Service Discipline

Desired Skills:
General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen, Service - Working Across Boundaries

Functional Skills:
Claim - Claim processing - Medical - Medicare

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 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.

Click To Review Our Benefits (PDF)


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