Aetna Claims Assesor role (1 year - contract to hire) in Singapore, Singapore

Req ID: 55898BR

Summary/Mission

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.

Position Summary/Mission

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.

Background/Experience Desired

· 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.