Aetna Sr Claim Benefit Spec in Lansing, Michigan

Req ID: 50743BR


Subject Matter Expert for stop loss team providing basic training and coaching along with review of complex specific claim issues. First-level contact for escalated files. Responsibility for special duties which support the overall stop loss team goals.

Fundamental Components:

Manages the escalation of complex cases from Analysts to Team Lead or Stop Loss Management

Will be responsible to review contracts, capture data, and present data to outside parties.

Trains and mentors Stop Loss Analysts and other staff

May be required to release and direct print provider payments

Month end review process to identify specific stop loss claims/filings requiring urgent and timely submission

Assigned Analyst for special handling clients or other claims related items

May perform other special functions as directed (e.g. In/Out Postings, Meritain Specific Accommodation, etc.)

Reconciliations of groups stop loss accounts.

Other duties as assigned and determined by Stop Loss management


Stop Loss processing experience preferred.

Experience in a production environment.

Claim processing experience preferred.

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.


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


Technical - Operating Systems/TE Windows XP/1-3 Years/End User


Opportunity to work in a fast pace environment as well as interact with multiple aspects of the organization including working with clients and brokers directly.

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