Aetna Sr Claim Benefit Specialist in Amherst, New York

Req ID: 52120BR

POSITION SUMMARY

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, or responding to complex issues. May handle customer service inquiries and problems.

FUNDAMENTAL COMPONENTS

Position Responsibilities: 1. Process claims in accordance with the plan document and Meritain internal guidelines 2. Meet and maintain the specified quality/quantity guidelines 3. Document all correspondence clearly and concisely 4. Attend and participate in monthly in-house staff meetings 5. Maintain acceptable turnaround time on inventory and pending inventory

BACKGROUND/EXPERIENCE

2+ years claim processing experience.

Experience in a production environment.

Claim processing experience.

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

EDUCATION

The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Claims/Claim processing - Medical or Hospital- HMO/1-3 Years

TELEWORK SPECIFICATIONS

Full-Time Telework (WAH) or if local to an Aetna office option to work in office is space permits

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.

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.

Job Function: Claim