Appeal Examiner

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.

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

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.

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