Life Claim Analyst- HYBRID Schedule

Job DescriptionFast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members and employer groups. Secure analyze and approve claim information to make recommendations for approval or denial of life claims. Manages/adjudicates a wide range of assigned Life and Health claims, independently, seeking guidance and direction for more complex claims in accordance with the terms of the contracts.Has responsibility for constituent satisfaction according to Aetna policies and practices.Performs detailed analysis and documentation of claim data to direct effective outcome.Coordinates investigations with consultant, interprets insurance contracts to determine Aetna's liability.Determines claimant's eligibility and qualification for benefits and extent of terprets insurance contract to determine Aetna's liability.Ensures compliance with contract provisions and state/federal regulations.Effectively uses outside vendors to obtain information according to dependently prepares all claim denials with review from Consultant or Manager.Makes accurate claim decisions in accordance with the terms of the contracts.Responds to claim and account inquiries from claimants, policyholders and other interested parties and creatively resolves issues through effective verbal and written communication and by involving appropriate people within or outside Aetna.Contributes new ideas and concepts in a constantly changing environmentRequired Qualifications1 year of health claims or equivalent related experience6months- 1 Year of Health insurance ExperienceHYBRID SCHEDULE Strong math aptitude.Proven analytical ability.Strong verbal and written communication skills.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications1 year of health claims or equivalent related experienceEducationHS Diploma or equivalent industry experience.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04