Monday , May 27 2024

Aetna Employment – Senior Claim Data Specialist

Website Aetna

Job Description:

This is a full time telework position. Qualified candidates may reside in any state (US). The Senior Claim Data Specialist handles end-to-end processes associated with claim data management. Identifies and addresses issues impacting auto-adjudication levels and claim accuracy. May complete manual plan-set-up activities associated with new business/account implementations.

Job Responsibilities:

  • Assists with the development and testing of new or enhanced product offerings as assigned.
  • Presents information effectively to various levels of employees and management through various formats, i.e. one on one, staff/customer meetings, presentations, etc.
  • Leads process improvement initiatives to improve productivity, accuracy and/or customer service and tool development. Manages assigned projects and ensures project plans and/or work tasks align with overall organizational goals.
  • Analyzes and determines if products and services selected by customers are aligned with their benefit needs and can be adequately supported through existing systems or operating platforms; alternately, seeks solutions and negotiate essential requirements in support of any non-standard plan selections.
  • Provides supervisory back up and assists in the delegation of issues and proposes streamlined workload assignments.
  • Mentors other employees associated with claim data management (e.g. provides technical expertise to team/unit).
  • Performs as Subject Matter Expert for the team relative to complex set-up, processing, system, policies and/or department workflows, meeting internal/external deadlines for production and quality of various products and services.

Job Requirements:

  • Excellent written and oral communication skills.
  • Minimum of one year of recent and related direct customer service experience.
  • Ability to manage multiple priorities.
  • Proficiency in all claim platforms and/or products, i.e. Traditional, HMO, HNO.
  • Ability to work collaboratively within work teams.
  • Minimum three years recent and or related claim processing experience.
  • Demonstrated proficiency with personal computer, keyboard navigation skills and with MS Office Suite applications.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Columbus, OH, US

Application Deadline: N/A

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