*This is a full time Work at Home opportunity in U.S. for the right candidate.
POSITION SUMMARY: As a member of the National Center of Excellence (COE) for COB Reporting and Analysis you will have a key role in identifying medical cost savings opportunities by data mining historical claims for competitor reimbursement trends.
- Responsibilities include financial modeling of hospital and physician claims for our competitors vs. Aetna’s reimbursement to identify areas of opportunity, and advising network management on opportunities to achieve medical cost savings.
- Must have a complete understanding of contract compensation, claims processing/payment policy rules, as well as the ability to turn data into information.
- Must be able to develop and implement project plans working collaboratively with peers, across teams and provide management updates.
- Bachelor’s degree or equivalent experience.
- Requires an understanding of the healthcare industry, healthcare data, common healthcare terminology and medical cost issues and strategies.
- Must be skilled in claims processing guidelines, ACAS benefit plans and member out of pocket components and systems (ex: ACAS, EWMP, MSW, SCM, etc.), and able to work with Microsoft Excel.
- Aetna “Data Warehouse” and other software experience (ex: Microsoft Access, SQL, DAF, Visual Basic, etc.) a plus but not required.
- Need ability to meet tight deadlines, within context of potentially changing priorities, working both independently and facilitating cross-functional solutions.
- Capable of taking project through issue identification and resolution/recommendation stages.
- General Business- Applying Reasoned Judgment, Ensuring Project Discipline, Turning Data into Information and Communicating for Impact.
- Finance/Servicing Customers Profitably.
- Claims/Claim Processing – Medical or Hospital – ACAS/4-6 Years
- Claims/Claim Processing – Medical or Hospital- HMO/4-6 Years
- Network/Medical Cost Management/1-3 Years
- Network/Medical Economics/1-3 Years
- Network/Provider Relations/1-3 Years
Please note that benefit eligibility may vary by position. Go here (http://www.aetna.com/working/assets/2010_All_Benefits_Rates_at_a_Glance_OCT1.pdf) to review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.To apply, go to https://sjobs.brassring.com/1033/ASP/TG/cim_jobdetail.asp?jobId=1608&PartnerId=25276&SiteId=5012&type=search&JobReqLang=1&recordstart=1