Job Description
• Performs ongoing research, and support tasks for existing systems. Utilizes appropriate resources in the management of each claim• Works with internal audit and reporting team to identify impact of the issue and collaborate on resolution.develops creative alternatives• Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis.• Meets timeliness standards in relation to communications and claim management activities. • Technically competent in the use of all Microsoft products, Word, Excel etc. • Ability to work independently as well as in group setting.• Proactively influences changes to repricing systems to support ongoing process and auto adjudication improvement• Submits Business Requests for enhancement/break-fix. Query data to justify enhancement cost.• Supports and participates in testing systems/process as required• Supports Project leads as required.
Required Qualifications
-Problem Solving and Analytical skills-Strong collaboration and communication skills-Healthcare claims processing knowledge-Data interpretation and analysis experience
Preferred Qualifications
-Experience with databases as well interpretation and manipulation of related data-Familiarity of Aetna systems ( e.g EPDB, SCM, Repricer, -BAMR, SCSR) is a plus.
Education
Bachelor's degree is a plus
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.