Job Summary

Aetna is seeking a highly organized and detail-oriented Claims Associate to join our dynamic healthcare team. The ideal candidate will play a pivotal role in processing, reviewing, and managing insurance claims, ensuring accurate and timely reimbursements while providing exceptional support to our members. This position offers the opportunity to contribute to a leading healthcare organization that values integrity, efficiency, and excellence in service.

Key Responsibilities

• Accurately review, process, and adjudicate medical, dental, or other health insurance claims in accordance with company policies and regulatory guidelines.

• Investigate and resolve claim discrepancies, incomplete information, or billing errors.

• Collaborate with healthcare providers, internal teams, and members to obtain necessary documentation and clarify claim issues.

• Ensure timely claim submission and adherence to internal performance metrics.

• Maintain accurate and detailed claim records, reporting trends or issues as needed.

• Assist in audits and compliance initiatives to ensure adherence to legal and organizational standards.

• Provide excellent member support by responding promptly to inquiries and resolving concerns effectively.

Required Skills and Qualifications

• High school diploma or equivalent; associates or bachelors degree in healthcare administration, business, or related field preferred.

• Strong attention to detail and organizational skills.

• Excellent verbal and written communication skills.

• Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and claims processing software.

• Ability to analyze and interpret complex information accurately.

• Strong problem-solving skills and ability to handle confidential information.

Experience

• Minimum 1-2 years of experience in claims processing, healthcare administration, or insurance-related roles preferred.

• Familiarity with medical coding, claim adjudication, and insurance policies is a plus.

Working Hours

• Monday to Friday, standard office hours.

• Fixed schedule with no weekend shifts.

• Remote or hybrid work options may be available based on organizational policies.

Knowledge, Skills, and Abilities

• In-depth knowledge of health insurance claims and processing procedures.

• Strong analytical and critical thinking capabilities.

• Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.

• Customer-focused mindset with a commitment to quality service.

• Team player with strong interpersonal skills to collaborate with cross-functional departments.

Benefits

• Competitive salary with performance incentives.

• Comprehensive medical, dental, and vision insurance.

• Paid time off, holidays, and wellness programs.

• 401(k) retirement plan with company match.

• Career development opportunities and continuous learning programs.

• Employee assistance programs and supportive work culture.

Why Join Aetna

Joining Aetna means being part of a leading healthcare company committed to improving lives and providing innovative solutions for our members. We foster an inclusive environment that values diversity, collaboration, and professional growth. Here, your contributions make a meaningful impact on the health and well-being of millions of people.

How to Apply

Interested candidates are invited to submit their resume and cover letter through Aetnas official careers portal: Aetna Careers

• Include the position title Claims Associate – Monday-Friday Fixed Schedule in your application.

• Only shortlisted candidates will be contacted for further assessment.