Job Summary

Aetna, a leader in the healthcare industry, is seeking a detail-oriented and analytical Billing & Claims Analyst to join our US Healthcare team. The ideal candidate will play a critical role in ensuring accurate processing of medical claims, timely resolution of billing issues, and adherence to regulatory compliance standards. This position requires someone with strong analytical skills, excellent communication, and the ability to thrive in a dynamic healthcare environment.

As a Billing & Claims Analyst at Aetna, you will be at the forefront of helping patients and providers navigate the complexities of healthcare billing while maintaining the highest standards of accuracy and service.

Key Responsibilities

• Review, analyze, and process incoming healthcare claims to ensure compliance with Aetna policies and federal/state regulations.

• Identify and resolve billing discrepancies and errors by working closely with providers, patients, and internal teams.

• Maintain accurate records of claims activity, billing adjustments, and follow-up actions.

• Perform audits on claims and billing data to detect trends, irregularities, or potential fraud.

• Collaborate with cross-functional teams, including Customer Service, Provider Relations, and Finance, to resolve complex claims issues.

• Prepare reports and summaries for management, highlighting claims trends, issues, and improvement opportunities.

• Support the implementation of process improvements to streamline claims processing and enhance operational efficiency.

• Ensure adherence to confidentiality, data protection, and HIPAA regulations in all claim-related activities.

Required Skills and Qualifications

• Proven experience in healthcare billing, claims processing, or medical coding.

• Strong understanding of US healthcare billing regulations, insurance policies, and medical terminology.

• Proficiency in claims management systems, EMR/EHR software, and Microsoft Office Suite (Excel, Word, PowerPoint).

• Excellent analytical and problem-solving skills.

• Strong verbal and written communication skills, with the ability to explain complex information clearly.

• High attention to detail and accuracy in handling sensitive healthcare data.

Experience

• Minimum 2–4 years of experience in healthcare claims processing, medical billing, or related roles.

• Experience with large healthcare organizations, insurance providers, or managed care organizations is preferred.

• Exposure to claim audits, billing reconciliations, and process improvement initiatives is an advantage.

Working Hours

• Full-time, Monday to Friday, standard office hours (flexible start/end times may be available).

• This position is fixed office-based; occasional overtime may be required to meet deadlines or address urgent claims issues.

Knowledge, Skills, and Abilities (KSAs)

• In-depth knowledge of medical billing codes (CPT, ICD-10, HCPCS) and claims adjudication processes.

• Ability to interpret complex insurance policies and healthcare regulations.

• Strong organizational skills and the ability to manage multiple priorities effectively.

• High ethical standards, integrity, and commitment to confidentiality.

• Capability to adapt quickly to changing processes and healthcare industry requirements.

Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer contributions.

• Paid time off, holidays, and sick leave.

• Professional development and training opportunities.

• Employee wellness programs and supportive workplace culture.

Why Join Aetna?

At Aetna, we are committed to transforming healthcare and improving the lives of our members. Joining our team means working in a collaborative, inclusive environment where your expertise is valued, and your contributions have a real impact. You will be part of an organization that prioritizes innovation, growth, and the well-being of both employees and members.

How to Apply

Interested candidates should submit their updated resume and a cover letter highlighting relevant experience via the Aetna Careers portal or email directly to us. Please include Billing & Claims Analyst – US Healthcare in the subject line.