Aetna Claims Associate (One Year Contract) - 55281BR in Dubai, United Arab Emirates

Req ID: 55281BR

--((Please note that this is a One Year Contract role, the visa will be sponsored by Aetna))--

About Aetna

Aetna International is a leading provider of international expatriate private medical insurance and health management solutions. We have over 1000 staff and growing every day. Our customer base is over 123,000 members located worldwide; and we have more than 71,000 health care professionals and facilities worldwide in the offices in all the major regions of the world.

Position Summary

Reviews and adjudicates claims in accordance with claim processing guidelines.

Fundamental Requirements

  • Triage and logging of incoming claims.

  • Scanning claims to work-queues for processing across all operational platforms.

  • Provider claims batch control linked between theplatform (Actisure IG, Actisure Aetna, and OpenHealth Plus).

  • Management of provider payments - create/run a provider bordereau, check that all invoices match the provider submission summary, identify and re-open for corrections where required, release the batch to finance for payment and once paid liaise with network team to inform the provider of the payment and claim details.

  • Claims vendor queries - reviewing claims on the various platforms, investigating processing queries and responding as appropriate to ensure that the claims batch flows.

  • Provider claims batch control linked between theplatform (Actisure IG, Actisure Aetna, and OpenHealth Plus).

  • Management of suspended claims including outreach by calls and emails where appropriate.

  • Finance queries - including managing OFAC issues- investigating, resolving issues and liaising with finance and customer toresolution.

  • Payment report management - investigating processed payments pending (not paid) and identifying a solution to release the payment.

  • E-claims reconciliation - Utilizing the recontool to investigate, identify, correct and manually remit where e-claim remittance has failed.

  • Manual claims reconciliation - reviewing re-subson the various platforms to identify current status, outstanding issues,correcting, and liaising with the claims vendor for processing

  • Continually work to improve best practices procedures and standards.

  • Ensures compliance with requirements of regional compliance authority/industry regulator.

  • Adheres to international privacy policies,practices and procedures.

Background/Experience Desired

  • 2 years experience in a production environment

  • Claim processing experience

  • Data entry experience.

Desired Education and Certification Requirements

  • High School graduate or local market equivalent.

Additional Information

  • Ability to maintain accuracy and production standards.

  • Analytical skills.

  • Technical skills.

  • Excellent communication skills.

  • Oral and written communication skills.

  • Understanding of medical terminology.

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Job Function: Claim

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.