Skip to main content

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

Senior Claim Assessor role, Singapore

Primary Location: Singapore
Additional Locations: SGP-Singapore

Job Group Summary

Fast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it's most needed.

Family Summary/Mission

Achieve superior claim and member service performance through an integrated process of operational, quality,medical cost, and resource management meeting and/or exceeding member, plansponsor, and provider expectations.

Position Summary/Mission

Reviews and adjudicates complex,sensitive, and/or specialized claims in accordance with claim processing guidelines. Acts as a subject matter expert by providing training, coaching, corresponding to complex issues. May handle customer service inquiries and problems.

Fundamental Components & Physical Requirements

·Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.

·Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.

·Handles phone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.

·Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures.

·Identifies and reports possible claim overpayments, underpayments and any other irregularities.

·Performs claim re-work calculations.

·Distributes work assignments daily to junior staff.

·Trains and mentors claim benefit specialists.

·Makes outbound calls to obtain required information for First claim or re-consideration.

·Trained and equipped to support call center activity if required, including general member and/or provider inquiries.

Background Experience Desired

·Experience in a production environment.

·Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

·2+ years claim processing experience.

·Claim processing experience.

Education and Certification Requirements

Associate's degree or equivalent work experience.

Additional Information

·Understanding of medical terminology.

·Strong knowledge of benefit plans, policies and procedures.

·Oral and written communication skills.

·Ability to maintain accuracy and production standards.

·Technical skills.

·Analytical skills.

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Click To Review Our Benefits (PDF)


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.