Sr Claim Benefit Specialist

Reviews and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May be required to learn multiple Medicaid plans. Claims processing experience is a basic requirement.

Critial success factors: – Flexibility

– Ability to learn and think outside the box

– Possess a good work ethic/organized & focused

Fundamental Components:

This position offers the opportunity to greatly broaden different skill sets and knowledge of state Medicaid plans. The work is diverse which enhances a candidates potential for future advancement within the company.

BACKGROUND/EXPERIENCE desired:

2+ years claim processing experience.

Experience in a production environment.

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

Knowledge of Excel

Root Cause Analysis

Experience working in QNXT, EDI, EMS, Systems preferred

Medical coding and billing

EDUCATION

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

LICENSES AND CERTIFICATIONS

Claims/ is desired

FUNCTIONAL EXPERIENCES

Functional – Claims//1-3 Years

TECHNOLOGY EXPERIENCES

Technical – Aetna Applications//1-3 Years/

Technical – Desktop Tools//1-3 Years/

Technical – Operating Systems//1-3 Years/

REQUIRED SKILLS

General Business/Communicating for Impact/FOUNDATION

General Business/Maximizing Work Practices/ADVANCED

Service/Demonstrating Service Discipline/FOUNDATION

DESIRED SKILLS

Service/Creating a Differentiated Service Experience/FOUNDATION

Service/Handling Service Challenges/ADVANCED

Service/Working Across Boundaries/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.