Aetna Pharmacy Claims Benefit Specialist in Amherst, New York

Req ID: 36257BR

This is an office based role. Candidates must work out of one of the following offices: Plymouth, MN, Tampa, FL, Amherst, NY.

Current internal teleworkers may continue to work at home. All others will be office based.


Reviews and processes vendor invoices for payment accuracy in accordance with invoice processing guidelines.

Fundamental Components:

Analyzes, creates, and approves routine claims that cannot be auto adjudicated.

Determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in accurate invoice processing.

Coordinates responses for routine phone inquiries and written correspondence related to invoice and claims processing issues.

Routes and triages complex claims to Analyst team and Leadership.

May facilitate training when considered topic subject matter expert.

In accordance with prescribed operational guidelines, manages invoicing on desk, internal and external inquires, as well as claim validations within specified turn-around-time parameter (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).

Utilizes all applicable system functions available ensuring accurate and timely claim and invoice processing service.

Other duties as assigned.


High school diploma or equivalent required.

Experience in a production environment

Claim processing experience, with skills in analyzing claims data for discrepancies

Ability to maintain accuracy and production standards with high attention to detail

1 year of PBM experience preferred


The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.


Claims/ is desired

Pharmacy/ is desired

Customer Service/ is desired


Claims/Claim processing - Pharmacy/1-3 Years is preferred

Administration / Operations/Data Entry/1-3 Years is required

Claims/Policies & procedures/1-3 Years is preferred

Telework Specifications:

telework / office-based schedule (must live near Plymouth, MN, Evansville, IN, Okemos, MI). Option for telework will be evaluated after six months of employment.


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Job Function: Claim