Aetna COB Verification Analyst in Harrisburg, Pennsylvania

Req ID: 40619BR

POSITION SUMMARY

Positively impact PMPM costs by developing and administering cost management programs to reduce medical claim

expense and identify and recover medical claim expense dollars from liable parties.

Fundamental Components:

Review insurance information for completeness/accuracy

Research and collect other insurance information through a variety of sources/reports; conducts research via

outbound calls or written correspondence to members, plan sponsors, providers, insurance companies, and other

parties

Research and respond to order of payment determinations using Medicare Secondary Payor (MSP) and National

Association of Insurance Commissioners (NAIC) guidelines. Coordinate response with claim processor

Investigate known or potential accident claims to determine Aetna responsibility and subrogation potential

Review and respond to Target, ECHS, KANA, and to written correspondence from Patient Management

Determine order of benefits based on guidelines. Update database with appropriate Order of Benefits and documents

appropriately

Delivers training programs, internally and externally regarding Coordination of Benefits

Maintains and utilizes all resource materials to manage job responsibilities

Exhibits behaviors outlined in Employee Competencies.

BACKGROUND/EXPERIENCE desired:

Claim processing experience

EDUCATION

The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Claim