Claims Inquiry Claims Research

About Our Company
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.

RESPONSIBILITIES
- Receive inquiries, from providers regarding claim status by telephone; answer call within established company standards
-Maintain an accurate online communications call log in accordance to department guidelines
-Analyze telephone communications for proper course of action (i.e., grievance or resubmission) and necessary research
-Determine if adjustment is warranted; take appropriate action as defined by department standards and policies
-Review history of claim in question; research particulars; contact appropriate personnel to verify information
-Identify and report issue trends in order to minimize future claims process issues
-Develop, establish, and maintain a work priority system to ensure daily and heavy workloads are fulfilled
-Maintain minimum telephone and claims processing standards
-Work in a manner that is not disruptive to peers, supervisors, and subordinates

Required Skills:
REQUIRED SKILLS/EXPERIENCE
- Incumbent must have exceptional oral and written communication proficiency
- attention to detail and ability to multi-task; posse s strong organizational skills
- Capacity to establish and maintain constructive business relationships with internal/external customers while maintaining integrity and confidentiality
- Aptitude to research, analyze and successfully resolve a broad spectrum of issues
- Intermediate skill level with Word and Excel required
- Experience in claim adjudication with an automated claim processing system
- Incumbent must be a positive, professional team player, able to manage project time constraints and work with little supervision
- High school diploma or equivalent required
- Incumbent must have three (3) years basic medical claims experience in a Managed Care Organization (MCO)
- One (1) year advanced claims processing experience, including COB/TPL, reversals, appeals, grievances, special handling, analysis, and research
- Working knowledge of Medicaid, Medicare

Schaller Anderson is an affiliate of Aetna.  We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

To learn more about this opportunity, visit us at www.aetna.com/working 23311

Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.

We conduct pre-employment drug and background testing.
No agencies, please.


We are an equal opportunity/affirmative action employer.