Aetna Claim Benefit Specialist in High Point, North Carolina

Req ID: 55404BR


Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.

Fundamental Components:

  • Determine and understand the coverage provided under a member's health plan

  • Efficiently use multiple systems and screens to obtain and record claim information

  • Review claims information to determine the nature of a member's illness or injury

  • Identify claim cost management opportunities and refer claims for follow up

  • Make claim payment decisions

  • Process claims accurately to enhance customer satisfaction and retention

  • Process claims within quality and production standards

  • Assist team members in support of achieving team, office, regional, and national goals


Experience in a transactional/production environment preferred. Experience in Microsoft Word, Excel, Power Point and Outlook. Strong verbal and written communications, listening skills and knowledge in problem solving.


The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.


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


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

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

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


General Business/Maximizing Work Practices/FOUNDATION

Service/Creating a Differentiated Service Experience/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION


Service/Demonstrating Service Discipline/FOUNDATION

Service/Handling Service Challenges/FOUNDATION

Service/Working Across Boundaries/ADVANCED


We are looking for a customer focused individual who enjoys working in a team environment and can create value by anticipating and exceeding customer expectations. The ideal candidate will have exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude. Prior medical claim processing experience is a plus. Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction. Comprehensive training will be provided to assist in the achievement of these objectives. Attendance during this training period is critical to your success. After completion of the training period, overtime may be required based on business needs. Attendance during the 12 week training period is critical to the success of this position. Applicants should be prepared to be present during the entire training period.

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.