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Appeal Examiner ID-14176

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

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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