75148BR
Job Description:
Reviews and adjudicates routine claims in accordance with claim processing guidelines.
Critical success factors - Ability to work independently - Ability to think logically and problem solve - Strong oral communication skills.
Req#:
75148BR
Job Group:
Claim
Full or Part Time:
Full Time
Supervisory Responsibilities:
No
Percent of Travel Required:
0 - 10%
Posting Job Title:
Medical Claim Processor
Potential Telework Position:
No
Additional Locations:
CA-Fresno, TX-Arlington
Primary Location (City, State):
CA-Fresno
EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer
Resource Group:
1
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.
Fundamental Components:
Analyzes and approves routine claims that cannot be auto adjudicated.
Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
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.
Background Experience:
Experience in a production environment.
Medical claim processing experience preferred but not required.
Medical coding background a plus but is not required.
Benefits Program:
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.
Clinical Licensure Required:
N/A