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For your reference, we have included the original job posting below.
Claim Benefit Specialist
Job Number:
43380840
Company Name:
Aetna
Job Location:
Fresno, CA US
Job Category:
Accounting & Finance
Claim Benefit Specialist
Claim Benefit Specialist Job Group Claim Auto req ID 6267BR Locations CA-Fresno Percent of Travel Required 0 - 10% Potential Telework Position No Full or Part Time Full Time Supervisory No Pay Opportunity Min $28,100 Pay Opportunity Max $37,100 Bonus Potential Variable % Job Description EXTERNAL CANDIDATES: Go to apply for this OTclick on the "apply to job" RENT EMPLOYEES: Please use JobLink.
POSITION SUMMARY Reviews and adjudicates routine claims in accordance with claim processing guidelines. 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. Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. 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. In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor). May facilitate training when considered topic subject matter expert.
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 Claims/Policies & procedures/1-3 Years Communications/Employee communications/1-3 Years
ADDITIONAL JOB INFORMATION This role is located in the Fresno, CA office.
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the ERNAL CANDIDATES: Go to apply for this OTclick on the "apply to job" RENT EMPLOYEES: Please use JobLink.
