Disability Adjudicator

About the Company

Aetna, a CVS Health company, is one of the nation’s leading diversified health care benefits companies, serving an estimated 39 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services.

Job Description

As a Disability Adjudicator at Aetna, you will play a crucial role in evaluating medical information, vocational data, and policy provisions to make accurate and timely determinations on disability claims. This position requires meticulous attention to detail, strong analytical skills, and a commitment to fair and objective decision-making, ensuring members receive the benefits they are entitled to.

Key Responsibilities

• Review and analyze complex medical records, treatment plans, and vocational assessments to determine eligibility for short-term and long-term disability benefits.
• Apply relevant medical criteria, contractual provisions, and legal requirements to render claim decisions.
• Communicate with claimants, physicians, employers, and other parties to gather necessary information and clarify ambiguities.
• Prepare clear, concise, and defensible rationale for all claim determinations, both approvals and denials.
• Manage a caseload effectively, prioritizing tasks to meet service level agreements and regulatory guidelines.
• Participate in team meetings and training sessions to maintain up-to-date knowledge of policies, procedures, and industry best practices.

Required Skills

• Proven experience of at least 3 years in claims adjudication, preferably in disability, health, or life insurance.
• Strong analytical and critical thinking abilities.
• Excellent written and verbal communication skills.
• Proficiency in interpreting medical terminology and clinical information.
• Ability to work independently and manage a demanding workload.
• Bachelor's degree in a related field (e.g., healthcare administration, nursing, social work, business).

Preferred Qualifications

• Certified Disability Management Specialist (CDMS) or similar professional certification.
• Experience with ERISA regulations and state/federal disability laws.
• Familiarity with Aetna's claims processing systems.
• Master's degree in a related field.

Perks & Benefits

• Comprehensive health, dental, and vision insurance.
• 401(k) retirement plan with company match.
• Generous paid time off and holidays.
• Tuition reimbursement program.
• Wellness programs and employee assistance initiatives.
• Professional development and career advancement opportunities.

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