Aetna WC Integrated Services Associate in Tampa, Florida

Req ID: 39081BR

POSITION SUMMARY

The Worker's Comp Integrated Service Associate reviews and adjudicates routine claims in accordance with claim processing guidelines. In this role you will be successful if you can work independently and have the ability to think logically and problem solve!

This position can work an 8 hour shift in between the hours of 6AM and 5PM in their time zone. The latest shift would start at 8:30 AM. You are able to choose the time you want to start after training is done as long as it falls within those hours!

The requirement is to start in the Tampa, FL, Plano, TX or Tucson, AZ office and then after at least 6 months and depending on performance there is an opportunity to work from home.

Fundamental Components

  • 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.

  • 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 customer service is needed!

Strong basic knowledge of Microsoft Outlook and Word

Microsoft Windows knowledge (meaning close open and minimize windows)

Experience in a production environment.

Claim processing experience is a high priority

Worker's Compensation CPT/HCPC ICD-10 is highly preferred

EDUCATION

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

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.

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.

Job Function: Workers' Compensation