Apr 08, 2018

Entry Level Claims Associate UAE Jobs - Aetna

  • Aetna Inc.
  • Dubai - United Arab Emirates
Full time Admin, Secretarial and PA Jobs Customer Service and Call Center Jobs Insurance Jobs

Job Description

Job Title:  Claims Associate

Company Name: Aetna

Location: Dubai, United Arab Emirates (UAE)

 

About Aetna:

Aetna International is a leading provider of international expatriate private medical insurance and health management solutions. We have over 1000 staff and growing every day. Our customer base is over 123,000 members located worldwide; and we have more than 71,000 health care professionals and facilities worldwide in the offices in all the major regions of the world.

 

Job Summary: The Claims Associate reviews and adjudicates claims in accordance with claim processing guidelines.

 

Key Duties and Responsibilities:  

  • Triage and logging of incoming claims.
  • Scanning claims to work-queues for processing across all operational platforms.
  • Provider claims batch control linked between the platform (Actisure IG, Actisure Aetna, and OpenHealth Plus).
  • Management of provider payments - create/run a provider bordereau, check that all invoices match the provider submission summary, identify and re-open for corrections where required, release the batch to finance for payment and once paid liaise with network team to inform the provider of the payment and claim details.
  • Claims vendor queries - reviewing claims on the various platforms, investigating processing queries and responding as appropriate to ensure that the claims batch flows.
  • Provider claims batch control linked between the platform (Actisure IG, Actisure Aetna, and OpenHealth Plus).
  • Management of suspended claims including outreach by calls and emails where appropriate.
  • Finance queries - including managing OFAC issues- investigating, resolving issues and liaising with finance and customer to resolution.
  • Payment report management - investigating processed payments pending (not paid) and identifying a solution to release the payment.
  • E-claims reconciliation - Utilizing the recon tool to investigate, identify, correct and manually remit where e-claim remittance has failed.
  • Manual claims reconciliation - reviewing re-subson the various platforms to identify current status, outstanding issues, correcting, and liaising with the claims vendor for processing
  • Continually work to improve best practices procedures and standards.
  • Ensures compliance with requirements of regional compliance authority/industry regulator.
  • Adheres to international privacy policies, practices and procedures.

 

Qualifications, Skills and Experience:

  • The applicant must be a high School graduate or local market equivalent.             
  • Two years’ experience in a production environment 
  • Claim processing experience 
  • Data entry experience.
  • Ability to maintain accuracy and production standards.
  • Analytical skills. 
  • Technical skills. 
  • Excellent communication skills. 
  • Oral and written communication skills. 
  • Understanding of medical terminology.

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