Aetna Clm Rptg &Spec Svcs Anly in Amherst, New York

Req ID: 54837BR


Acts as a liason and subject matter expert for Aggregate stop loss contracts between our internal and external clients and the stop loss administrators. Reviews and manages Aggregtae stop loss filings. Resolves discrepancies between the amount requested and amount reimbursed by the stop loss carrier.

Fundamental Components:

Acts as a principal point of contact for stop loss administrators. Review and investigate inquiries from stop loss administrators. Utilize all applicable system functions and department relationships to finalize stop loss aggregate filings. Maintaining good relationships with internal and external clients. Escalate complex issues to stop loss senior analyst or stop loss management as directed. Use reporting tools to maintain and manage daily work flow. Back up duties to support the stop loss team (e.g.PTO, absences, managing work loads, etc;) Other duties are assigned and determined by stop loss management.


Stop loss experience preferred. Claims processing background preferred. Ability to work independently and maintain service standards. Technical and analytical skills.


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


Functional - Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years


Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Telework Specifications:

Part-Time Telework (ex: 2 days office-based, 3 days telework)

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 candidates'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

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.