Aetna Stay At Home Jobs, Aetna Job Openings Work From Home #Apply Today ( Claim Benefit Specialist )
Hiring Organization: Aetna
Post Name: Claim Benefit Specialist
Qualification: Graduate
Industry: Private
Employment Type: Full Time
Work Hours: 8 Hours
Salary: $20-$30/Hour
Location: Tamarac, FL
Full Jobs Description
Evaluates and resolves routine Medicare claims from the HRP system in accordance with claims processing guidelines. Claims for assessment results must meet/exceed production and quality standards required by CMS and Aetna.
- Analyzes and validates routine requirements that cannot be resolved automatically.
- Adheres to medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies and implements all cost containment measures to assist in claims settlement.
- making a request or referral for evidence to determine, review or implement appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedures, diagnostic and pre coding requirements. - can facilitate training if you are considered an expert on the subject. -
- Manages requirements for desk, route/queues and ECHS (electronic mail handling system used to process correspondence scanned into the provider's system) within defined lead time parameters according to established operational guidelines.
- Utilizes all applicable available system functions to ensure accurate and timely processing of claims
- Note. Our CBS position in Medicare is not limited to prior claims. These positions may support various Medicare workflows based on business needs. This can be either FE requirements, special work or our rework team.
Salary range
- The typical salary range for this position is:
- Minimum: 5:00 p.m
- Maximum: 27.90
Required Qualifications
- Work experience in a manufacturing environment
- Detailed and quality oriented
- Ability to research and work with multiple computer applications simultaneously
- Microsoft Outlook
Preferred Qualifications
- Experience in handling complaints
- Computer navigation skills
- Production and quality background
- Microsoft Office Tools
Aetna Stay At Home Jobs, Aetna Job Openings Work From Home #Apply Today ( Claim Benefit Specialist )
