Aetna Medical Claims Analyst in Rockville, Maryland

Req ID: 53606BR

POSITION SUMMARY

Responsible for all aspects of recoveries including, medical claims processing, handling of retro termination and duplicate projects, refund and return check processing, stop payments/void processing, setting up and following up on overpayments, responding to customer inquiries and resolving customer concerns/issues, coordinate processing with other departments.

Fundamental Components:

Responsible for all aspects of recoveries including, medical claims processing, handling of retro termination and duplicate projects, refund and return checks processing, stop payments/void processing, setting up and following up on overpayments, responding to customer inquiries and resolving customer concerns/issues, and coordinate processing with other departments. Assess, investigate and resolve outstanding issues by using online resources, phone calls and written communication. Maintain quality goals and production.

BACKGROUND/EXPERIENCE desired:

Previous (2 to 3 years) medical claims processing and adjustment experience preferred.

Customer service experience preferred.

Effective communications, organizational, and interpersonal skills.

Demonstrated negotiation skills.

Effective keyboard skills; able to navigate within a computer/systems-dependent environment without assistance; previous experience in a windows-based computer environment preferred.

Displays a positive, confident attitude; highly self-motivated and accountable.

Demonstrated analytical and problem-solving skills.

Ability to absorb and apply new and changing information.

Independent decision making skills.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Claims/Claims Administration - coordination of benefits (COB) verification/1-3 Years

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

Functional - Claims/Overpayment recovery/4-6 Years

Functional - Claims/Claim processing - Medical - Medicare/1-3 Years

Functional - Customer Service/Customer service - production environment/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

ADDITIONAL JOB INFORMATION

Excellent class room training package. Interaction with other departments. Potential to grow within the department and company. Provide excellent customer service to internal and external customers.

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 candidates'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

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.