Aetna Complaint & Appeal Analyst in Linthicum, Maryland

Req ID: 37919BR

This is an office based role in Linthicum, MD.

POSITION SUMMARY

Complaint and Appeals Analyst that can make decisions payment decision that are based only on appropriateness of care and service and existence of coverage benefits.

Fundamental Components include but are not limited to:

Reviews eligibility and investigates benefits in accordance with Medical claim processing guidelines. Research and analysis essential to resolving claim denials. Have experience with billing practices and established billing guidelines (CMS) and surrounding medical terminology. Ability to work independently. Escalate unresolved appeals to the Appeals Manager for guidance. Ability to work cross functionally across multiple areas. Ability to maintain accuracy and production standards and/or metrics. Analytical skills. Technical skills. Excellent communication skills.

BACKGROUND/EXPERIENCE

-1-2 years of claims experience is required

-Special investigations, provider relations, customer service or audit experience is preferred.

-Experience in research and analysis of claim processing a plus.

EDUCATION

The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

Claim processing - Medical or Hospital - ACAS/1-3 Years

Medical/Miscellaneous Plans/1-3 Years

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Service/Demonstrating Service Discipline/FOUNDATION

DESIRED SKILLS

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Risk Management