Aetna Stop Loss Analyst in Plymouth, Minnesota

Req ID: 52101BR

POSITION SUMMARY

Acts as a liaison and subject matter expert between our internal and external clients and the stop loss administrators. Reviews and manages stop loss claim filings. Resolves discrepancies between the amount requested and the amount reimbursed by the stop loss carrier.

FUNDAMENTAL COMPONENTS

Acts as principal point of contact for stop loss administrators

Review and investigate inquiries from stop loss administrators

Manage and/or request retro pre-cert reviews, medical necessity inquiries, medical records & physician orders, etc.

Utilize all applicable system functions and department relationships to finalize stop loss filings

Perform manual processes related to mid-year takeovers, plan year end, special handling clients, stop loss policy reviews, etc.

Review Actively at Work (AAW) eligibility documents prior to submission to stop loss administrator

Review and resolve mismatched filings prior to submission to stop loss administrator (retention review, aggregating-specific review, etc.)

Review, adjudicate and appeal as necessary mismatched stop loss reimbursements

May process filings on other claim platforms (e.g. Eldorado, LuminX)

Maintaining good relationships with internal and external clients

Escalate complex issues to Stop Loss Senior Analyst or Stop Loss Management as directed

Use system reporting tools to maintain and manage daily work flow

May perform processes (In/Out Posting) to finalize stop loss reimbursements systematically

Manage special accommodation product as required

BACKGROUND/EXPERIENCE

Experience in a production environment.

Claim processing experience.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Claims/Payment management/1-3 Years

TECHNOLOGY EXPERIENCES

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

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

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