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Aetna Life Claim Processor in Franklin, Tennessee

Req ID: 71230BR

Job Description

Secure analyze and approve claim information to make recommendations for approval or denial of life claims. Lead Analyst for claim account management. Approval authority limit up to a maximum of $250,000.

Fundamental Components included but are not limited to:

  • Manages/adjudicates a wide range of assigned Life and AD&D claims, (including adverse claims and complex AD&D) independently, seeking guidance and direction for more complex claims in accordance with the terms of the contracts.

  • Has responsibility for constituent satisfaction according to Aetna policies and practices.

  • Performs detailed analysis and documentation of claim data to direct effective outcome.

  • Coordinates investigations with consultant, interprets insurance contracts to determine Aetna's liability.

  • Determines claimant's eligibility and qualification for benefits and extent of dismemberment.

  • Interprets insurance contract to determine Aetna's liability.

  • Ensures compliance with contract provisions and state/federal regulations.

  • Effectively uses outside vendors to obtain information according to guidelines.

  • Independently prepares all claim denials with review from Consultant or Manager.

  • Makes accurate claim decisions in accordance with the terms of the contracts.

  • Responds to claim and account inquiries from claimants, policyholders and other interested parties and creatively resolves issues through effective verbal and written communication and by involving appropriate people within or outside Aetna.Contributes new ideas and concepts in a constantly changing environment.

Qualifications Requirements and Preferences:

1 year as Life Trainee or equivalent related experience.

1-3 year experience Claim Processing

Bachelor's degree or equivalent industry experience.

Additional Job Information:

Strong math aptitude.Proven analytical ability.Strong verbal and written communication skills.

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Claim

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.