Aetna Claims Assesor role (1 year - contract to hire) in Singapore, Singapore
Req ID: 55898BR
Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.
Reviews and adjudicates claims in accordance with claim processing guidelines
Fundamental Components & Physical Requirements include but are not limited to
· Analyzes and approves claims.
· Completes work with a limited degree of supervision
· Assesses claims up to given Authority limit- lower $ value claims and advice from designated Specialists. (Senior Claim Benefits Specialist and Medical Claim Benefits Specialist colleagues).
· Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
· Investigate claims for possible abuse and fraud.
· Conducts outreach activities including but not limited to email, member calls, provider calls as part of the claims adjudication process
· In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters.
· Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).
· Escalate unresolved claims complaints and high costs claims to the claims supervisor for guidance.
· 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.
· 2 years experience in a healthcare claims environment.
· Claim assessment experience.
· Requires specialized skills in one area or a breadth of knowledge across multiple areas.
Education and Certification Requirements
High School graduate or local market equivalent.
Additional Information (situational competencies, skills, work location requirements, etc.)
· Ability to maintain accuracy and production standards.
· Analytical skills.
· Technical skills.
· Excellent communication skills.
· Oral and written communication skills.
· Understanding of medical terminology.
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.