Firm Name:  Aetna

Numbers of Jobs: Provider Claims Customer Service

Education Need: Graduate

Job Hours: 8

Payment: $20-$30/Hour

What's Job City: Minneapolis

Job Details:

• Based on correspondence from members, vendors, and plan sponsors, answers questions and solves issues. assigns the necessary personnel to the resulting rework. Provide excellent customer service to high-volume inbound provider calls for the Claims Inquiry/Claims Research team. An extensive analysis of claims across numerous platforms to assist providers with payment-related issues.
•  providing the client with the necessary information to address any inquiries they may have, e. g. Additional plan details, information on benefit plans, resources for member self-service, etc. The customer service threshold framework is used when making financial decisions to address member issues. outlines the member's contractually mandated rights and obligations.
•  The intended system manages claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievances, and appeals (member/provider).
•  helps providers understand our self-service options and educates them about them. assists providers with inquiries and problems regarding contracting, credentialing, and re-credentialing.
•  helps in the collection of claim data for customer audits. based on incoming correspondence and internal recommendations, establishes medical necessity, and appropriate coverage guidelines, and verifies member plan eligibility.
•  This position is under the control of the Service Operations department.

 Enjoy the advantages of working for a company that goes above and beyond to look out for its employees and the community, in addition to your salary. The company fully covers all medical, dental, and vision benefits. Eligible employees may join the company's 401(k) retirement savings plan and take advantage of the Employee Stock Purchase Plan. A fully paid term life insurance plan, along with short-term and long-term disability benefits, are provided to qualified employees by the company. Furthermore, CVS Health offers a range of wellness initiatives, educational support, free training sessions, CVS store discounts, and partner discounts. All year long, paid holidays and Paid Time Off (PTO) are available to Company employees. A certain number of paid holidays, sick days, and other time off are offered by the laws of the applicable state and corporate policies.

 To learn more about the benefits that are provided in detail, please visit.

 jobs. Go to CVSHealth.com/benefits.

 Essential requirements.

•  understanding of Microsoft Office applications.
•  (25 Mbps) Super-fast internet.
•  We provide a 6 to 12-foot-long ethernet cord, but if the distance is longer, you will need to provide your ethernet cable.

 Desirable Qualifications.

•  Claims and coding knowledge.

 Education.

•  High school diploma or GED equivalent.