Senior Claim Benefit Specialist - Operations

As a Senior Claim Benefit Specialist - Operations at Aetna, you will play a crucial role in ensuring that our members receive the benefits they are entitled to. Our team is dedicated to providing exceptional customer service, and we are looking for a knowledgeable and experienced individual to join us. In this role, you will have the opportunity to utilize your expertise in claims processing and operational efficiency to make a positive impact on our members' health care experience. If you are a detail-oriented, analytical thinker with a passion for helping others, we would love to hear from you. Join our team and become a part of Aetna's mission to build a healthier world.

1. Process and review complex medical claims to ensure accuracy and adherence to company policies and procedures.
2. Utilize knowledge of industry regulations and guidelines to ensure compliance with federal and state laws.
3. Investigate and resolve escalated customer inquiries and complaints related to claim benefits.
4. Collaborate with other departments to identify and implement process improvements to increase operational efficiency.
5. Train and mentor junior team members on claims processing procedures and policies.
6. Stay updated on changes in industry regulations and company policies to ensure accurate claims processing.
7. Utilize data and analytics to identify trends and patterns in claims processing and make recommendations for improvement.
8. Communicate with providers and other stakeholders to obtain necessary documentation and information for claims processing.
9. Maintain accurate and detailed records of claims processing activities.
10. Participate in team meetings and contribute ideas for enhancing customer service and improving processes.
11. Act as a subject matter expert and resource for complex claims inquiries and escalations.
12. Adhere to strict confidentiality guidelines and handle sensitive member information with discretion.
13. Continuously strive to provide exceptional customer service and meet or exceed performance metrics.
14. Collaborate with cross-functional teams to implement new processes and systems to improve overall operations.
15. Assist with special projects and initiatives to support the company's mission and goals.

According to JobzMall, the average salary range for a Senior Claim Benefit Specialist - Operations in Arizona, USA is $60,000 to $80,000 per year. However, this can vary depending on the specific company, location, and level of experience.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.