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Appeal Examiner id-10457

Job Description

Are you a highly analytical and detail-oriented individual with experience in the insurance industry? Are you passionate about helping others and making a positive impact in their lives? If so, Aetna is looking for you!As an Appeal Examiner at Aetna, you will have the opportunity to use your expertise to review and make decisions on appeals related to healthcare coverage. You will play a vital role in ensuring the fair and accurate resolution of disputes, while also providing exceptional customer service to our members.To be successful in this role, you must have a strong understanding of insurance policies and procedures, excellent communication and problem-solving skills, and the ability to work in a fast-paced and constantly evolving environment. If you are ready to join a dynamic team and make a meaningful difference, we encourage you to apply for this exciting opportunity at Aetna.

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  1. Review and evaluate appeal cases in a timely manner, utilizing your knowledge of insurance policies and procedures to determine appropriate resolution.
  2. Communicate effectively with members, providers, and other stakeholders to gather necessary information and provide updates on appeal status.
  3. Maintain accurate and detailed documentation of appeal cases and decisions made.
  4. Collaborate with other departments and teams to ensure consistency and accuracy in appeal decisions.
  5. Continuously stay updated on industry changes and regulations to ensure compliance in appeal processes.
  6. Provide exceptional customer service to members by addressing their concerns and questions regarding appeals.
  7. Analyze data and trends to identify areas for improvement in the appeals process.
  8. Participate in training and development opportunities to enhance knowledge and skills.
  9. Adhere to strict confidentiality and privacy policies to protect sensitive information.
  10. Support and promote Aetna's values and mission of improving the health and well-being of its members.

    Job Qualifications
    Bachelor's Degree In A Related Field Such As Law, Public Policy, Or Healthcare Administration.

    Minimum Of 3 Years Of Experience In Insurance Claims Processing Or Appeals Review.

    Knowledge Of Federal And State Healthcare Regulations And Laws, Including Erisa And Hipaa.

    Excellent Analytical And Critical Thinking Skills, With The Ability To Make Fair And Unbiased Decisions.

    Strong Communication And Interpersonal Skills, With The Ability To Effectively Communicate Decisions To All Parties Involved In The Appeal Process.

    Required Skills
    Time Management

    Interpersonal skills

    Attention to detail

    Written Communication

    Negotiation

    Research skills

    Active listening

    Problem-Solving

    Decision-Making

    Legal Analysis

    Case Evaluation

    Soft Skills
    Communication

    Conflict Resolution

    Leadership

    Time management

    creativity

    Critical thinking

    Teamwork

    Active Listening

    Adaptability

    Problem-Solving

    Compensation
    According to JobzMall, the average salary range for a Appeal Examiner is between $65,000 and $90,000 per year. However, this can vary depending on factors such as experience, location, and the employer. Some appeal examiners may also receive bonuses or commission based on their performance.

    Additional Information
    Aetna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
    Required Languages
    English
    Job Posted
    March 13th, 2025
    Apply Before
    May 22nd, 2025

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