Reviews and handles data in accordance with various Aetna policy guidelines.
- Timely handling of sensitive financial information
- Works cross-functionally with segment peers to successfully implement new business/account activity.
- Performs root cause analysis of items that may hinder claim system efficiency.
- Provides research support to business segment or cross segment peers associated with claim data management and integrity issues.
- Provides claim support assistance by making outbound calls to obtain necessary claim information.
- Analyzes and interprets plan benefits, policies, and workflows accurately.
- Routes and triages complex issues as needed.
- Reviews data to determine, review, or apply appropriate guidelines for coding, member identification, processes, and provider selection.
- May facilitate training when considered topic subject matter expert.
- Utilizes all applicable system functions available ensuring accurate and timely processing of items.
- Experience in a production environment.
- Customer service experience.
- Claim processing experience.
- High School or GED equivalent.
Additional Job Information
Understanding of medical terminology.Oral and written communication skills.Ability to maintain accuracy and production standards.Technical skills.Attention to detail and accuracy.Analytical skills.
High School diploma, G.E.D. or equivalent experience
Percent of Travel Required
0 - 10%
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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