Aetna Senior Claim Benefit Specialist in Newark, Delaware

Req ID: 45544BR

Only existing WAH employees can remain WAH; Candidate will work from Newark, DE, Jacksonville, FL, Houston, TX or Phoenix, AZ office.


Candidate will need to interpret and process all claim types, including difficult claims in accordance with company policies and procedures, while maintaining quality and production standards.

Fundamental Components:

Demonstrates advanced understanding of our Medicaid products and managed care industry. Adapts and effectively responds to shifts in priorities, new and changing job requirements and unexpected events. Interprets and processes adjustments in accordance with company policies and procedures. Reviews all pended claim types to determine appropriateness of claim status. Consistently meets or exceeds production standards based on units per hour. Consistently meets or exceeds quality standards while maintaining an acceptable level of adjustments as a percentage of claims processed.


2+ years medical claim processing experience is REQUIRED.

Experience in a production environment.

Demonstrated ability to handle multiple assignments competently, accurately and efficiently.


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

Telework Specifications:

Option for telework will be evaluated after a certain period of employment


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