This position is work at home in any state.
If you reside in a commutable distance to our Jacksonville, FL, / Fresno, CA / Bethlehem, PA / Arlington, TX / High Point, NC offices, the work at home option will be temporary and you will be expected to work onsite once we return to the office.
If you are outside of a reasonable commutable distance, the position will remain work at home.
• Reviews and adjudicates claims in accordance with claim processing guidelines.
• Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims.
• You will be a key link in providing our customers with prompt, efficient, high quality claim service.
• Determine and understand the coverage provided under a member's health plan.
• Efficiently use multiple systems and screens to obtain and record claim information.
• Review claims information to determine the nature of a member's illness or injury.
• Identify claim cost management opportunities and refer claims for follow up.
• Make claim payment decisions.
• Process claims accurately to enhance customer satisfaction and retention.
• Process claims within quality and production standards.
• Assist team members in support of achieving team, office, regional, and national goals.
• Experience in a quality and production environment.
• Attention to detail.
• Ability to use multiple computer applications at one time.
• Claim processing experience.
• High School Diploma required/Associates Degree preferred.
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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