Job Summary:

As a Billing & Claims Specialist at Aetna, you will play a critical role in ensuring the accurate processing, review, and resolution of medical insurance claims for our U.S.-based clients. You will serve as a key point of contact for internal teams, healthcare providers, and customers, ensuring claims are handled efficiently and in compliance with regulatory requirements. The ideal candidate is detail-oriented, proactive, and possesses a strong understanding of medical billing and insurance processes.

Key Responsibilities:

• Review, process, and adjudicate medical insurance claims with accuracy and timeliness.

• Identify discrepancies, resolve claim issues, and communicate with providers and clients to clarify billing information.

• Collaborate with internal teams, including customer service, finance, and compliance, to resolve complex billing issues.

• Maintain accurate records of claims, billing transactions, and communications in compliance with company policies and regulatory standards.

• Ensure compliance with federal, state, and local regulations related to medical billing and insurance claims.

• Provide support for audits, investigations, and reporting requirements.

• Assist in identifying process improvements to enhance billing accuracy and efficiency.

Required Skills and Qualifications:

• Strong knowledge of U.S. medical insurance, billing, and claims processes.

• Familiarity with ICD-10, CPT, HCPCS codes, and other medical coding standards.

• Proficiency with billing software and claims management systems.

• Excellent analytical, problem-solving, and organizational skills.

• Strong written and verbal communication skills.

• Ability to work independently and collaboratively in a fast-paced environment.

• Attention to detail and commitment to accuracy.

Experience:

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

• Experience working with U.S. healthcare insurance systems, including claims adjudication and billing reconciliation.

• Exposure to compliance requirements and regulatory standards is highly desirable.

Working Hours:

• Full-time position, standard business hours (Monday–Friday).

• Flexibility to accommodate occasional peak workloads or special projects may be required.

• Remote work options may be available depending on business needs.

Knowledge, Skills, and Abilities (KSA):

• Strong understanding of healthcare insurance plans, policies, and claims lifecycle.

• Proficient in Microsoft Office Suite, especially Excel for data analysis and reporting.

• Ability to interpret policy language and explain complex billing processes clearly.

• High level of confidentiality and integrity when handling sensitive information.

• Time management and multitasking skills to handle high volumes of claims efficiently.

Benefits:

• Competitive salary with performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• 401(k) retirement savings plan with company matching.

• Paid time off (PTO) and holiday leave.

• Professional development and training opportunities.

• Employee wellness programs and resources.

Why Join Aetna:

At Aetna, you will join a leading U.S. healthcare company committed to innovation, quality, and exceptional member experiences. You will work in a supportive and inclusive environment where your contributions directly impact the health and well-being of millions. This is an opportunity to advance your career while making a meaningful difference in peoples lives.

How to Apply:

Interested candidates are encouraged to submit their resume and a cover letter highlighting their relevant experience through Aetnas official careers portal: www.aetna.com/careers. Applications will be reviewed on a rolling basis, and selected candidates will be contacted for interviews.