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Aetna Claims Jobs (NOW HIRING)

CVS Health

Customer Service Representative

Carson City, NV · On-site

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors includecaring, beingaccountable,innovating ...

Oak St. Health

Customer Service Representative

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

Oak St. Health

Customer Service Representative

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

CVS Health

Customer Service Representative

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

CVS Health

Customer Service Representative

Home, PA · On-site

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

CVS Health

MI · On-site

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

Oak St. Health

Customer Service Representative

$17 - $31.30/hr

You will be responsible for educating customers about their benefits and claims while resolving ... Demonstrating CVS/Aetna's Values in Action behaviors include caring, being accountable, innovating ...

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All JobsFinance and Insurance JobsAetna Claims Jobs

Aetna Claims information

See salary details

$40K

$61.6K

$92K

How much do aetna claims jobs pay per year?

As of Sep 2, 2026, the average yearly pay for aetna claims in the United States is $61,600.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,000.00 and $65,500.00 per year, depending on experience, location, and employer.

What is an Aetna Claims?

An Aetna Claims job involves processing and reviewing insurance claims submitted by healthcare providers or policyholders. Claims representatives evaluate medical services, verify coverage, and ensure compliance with company policies and regulations. They may communicate with customers, healthcare providers, and internal teams to resolve claim issues. The role requires attention to detail, knowledge of insurance policies, and strong problem-solving skills.

What skills and qualifications are needed for an Aetna Claims?

To excel in an Aetna Claims position, candidates need strong analytical skills, attention to detail, and experience in medical billing or insurance claims processing, often supported by a high school diploma or related certification. Familiarity with claims management software, ICD-10/CPT coding, and proprietary Aetna systems is highly valuable. Excellent communication, problem-solving, and customer service abilities help professionals navigate complex claims and interact with providers and insured members. Mastery of these skills ensures timely and accurate claims adjudication while maintaining compliance and customer satisfaction.

What are common challenges faced in an Aetna Claims and how are they addressed?

Aetna Claims professionals often encounter complicated cases involving unclear or incomplete medical documentation, complex policy rules, or discrepancies in submitted information. These challenges are typically addressed through careful review, use of established protocols, and effective communication with providers, members, and other internal teams to gather missing details or clarify policy coverage. Guidance and support are available from supervisors and teammates, fostering a collaborative environment to resolve difficult claims. Staying current with industry updates and ongoing training also helps team members navigate the evolving insurance landscape.

Does Aetna offer remote positions?

Aetna claims and customer service roles often offer remote or telecommuting options, especially for positions that involve claims processing and customer support. Availability of remote work may depend on the specific role, location, and company policies, and some positions may require on-site presence or occasional in-office work.
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Aetna Claims jobs near you
Infographic showing various Aetna Claims job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $61,600 per year, or $29.6 per hour.

Insurance Follow Up Representative

Insight Global

White Marsh, MD • On-site

$17 - $20/hr

Full-time

Medical, Dental, Vision, Life

Posted 9 days ago

Job description

Must Haves:

  • High school diploma or equivalent
  • 3-5+ years experience in patient accounting/accounts receivable or related healthcare field.
  • Experience with Outpatient AND Inpatient hospital billing
    • Including experience with Maryland billing
  • Experience with facility claims follow-up & appeals handling
    • Experience with UB04 forms
    • This team handles all technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.)
  • Strong experience working with commercial (non-gov) payers (UHC, Aetna, Cigna, Medicare Advantage Plans, BCBS, etc.)
  • Experience working specifically with BlueCross BlueShield CareFirst and/or BlueCard
    • Familiarity using payer portal, their escalation process, how to read and interpret contracts
  • Experience meeting a productivity standard of following up on ~80 claims per day (95% accuracy)
  • Knowledgeable of ICD codes, CPT Codes, EOB, etc.
  • Attention to Detail:
    • Must be able to spot errors and inconsistencies in claims and contracts.
  • Analytical Thinking:
    • Capable of identifying discrepancies in claim pricing vs. payment. Must be able to determine whether a claim was underpaid, denied, or priced incorrectly.
  • Independent & Fast Learner
  • Tech Savvy (Excel, Teams, etc.) and experience working fully remotely

Preferred:

  • Experience with systems: Med-Connect for medical records, RCI (repository where denials go), Envision (SMS), Epic

Team Structure

  • 22–23 total team members: Director, Manager, 2 Supervisors, 3 Team Leads.
  • Reporting to Team Lead (Blue Cross Follow-Up) and Supervisor.

Day to Day:

Insight Global is looking for a Commercial Follow-Up Representative to support facility claims and technical denials for a large hospital system in the Maryland/DC area. This person is responsible for managing post-billing, specifically for Blue Cross Blue Shield, claim activity. This role focuses on resolving underpayments, denials, and contract interpretation issues—not clinical denials or patient balances. The representative ensures accurate reimbursement by analyzing Explanation of Benefits (EOBs), identifying discrepancies, and initiating corrective actions with commercial payers. This team focuses on facility claims only, and this role is focused only on claims follow up, specifically to commercial payers, including BCBS. The role focuses on resolving technical denials (underpayment or partial payment issues, authorization issues, COB issues, coding issues, misinterpretation of contract issues, etc.).

Primary Responsibilities:

Claims Management:

  • Take ownership of hospital (inpatient and outpatient) claims after billing, especially those that are denied or underpaid.
  • Determine what was paid, what was denied, and why.
  • Identify and resolve technical denials related to coding, underpayments or partial payments, denials, and contract interpretation issues.
  • Manage 60 accounts per day

Payer Interaction:

  • Handle all claims for Blue Cross Blue Sheild CareFirst and/or BlueCard.
  • Understand and navigate multiple contracts.
  • Utilize BCBS portal to follow up and resolve outstanding claim issues.
  • Interpret Explanation of Benefits (EOB) and payer methodology.

Analytical Review:

  • Differentiate between pricing errors vs. payment errors.
  • Accurately price claims based on contract terms and identify variances.

Scope of Work:

  • Facility claims ONLY
  • Commercial payers ONLY (non-government payers)