Aetna Legislative Consultant (Claim & Call Policy) in Allentown, Pennsylvania

Req ID: 40764BR

This Legislative Consultant (Claim & Call Policy) role can be located in Allentown, PA (internal candidates only); Moon Township, PA; Harrisburg, PA; Blue Bell, PA (internal candidates only); Hartford, CT (internal candidates only); New Albany, OH or Arlington, TX.

Candidates must be comfortable working out of one of these office locations. Aetna employees who are currently working from home may continue to work from home.

POSITION SUMMARYWe research and analyze state and Federal laws, determine actions required to comply and develop the procedures necessary to accurately adjudicate claims, answer member or provider calls or produce the necessary outcome to achieve compliance.

Fundamental Components of the Legislative Consultant (Claim & Call Policy) role include, but are not limited to:

We are looking for a highly motivated, detail-oriented Legislative Consultant (Claim & Call Policy) to join the RACR Claim/Call Policy Intake and Development Team. The successful candidate will be a well-organized team player with strong communication skills and Aetna product and claim systems knowledge. The candidate must be professional, reliable and provide prompt service to customers at all times, as well as being self-motivated, self-directed, and having the flexibility to work effectively within various teams/workgroups. Key responsibilities include:

  • Research and analyze state and federal laws, determine actions required to comply and develop the procedures necessary to accurately adjudicate claims, answer calls or produce the necessary outcome to achieve compliance.

  • Provide legislative/policy consultative services to other business areas (projects, workgroups).

  • Research existing policies, consulting with Compliance/Legal, working with other business areas (e.g., Systems, Product) and the service centers in the development of the business requirements/procedures to ensure compliance.

  • Describe, in plain writing, the functions required of claim or call personnel to comply with legislation.

    BACKGROUND/EXPERIENCE desired:

    The candidate must have:

  • the ability to manage multiple priorities and demonstrate some project management skills.

  • strong, positive, effective working relationships with team members, supporting interaction between teams and areas within and across organizational lines.

  • the ability to convey complex information in plain language.

  • current or prior experience in quality management, consulting, and/or contract management a plus!

    EDUCATION

    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    FUNCTIONAL EXPERIENCES

    Functional - Claims/Claim processing - Medical or Hospital - ACAS/4-6 Years

    Functional - Customer Service/Customer Service - Member Services - Traditional products/1-3 Years

    Functional - Products-Medical/All Aetna Standard Plans/1-3 Years

    Functional - Management/Management - Process and quality improvement/1-3 Years

    REQUIRED SKILLS

    General Business/Communicating for Impact/FOUNDATION

    General Business/Demonstrating Business and Industry Acumen/FOUNDATION

    General Business/Maximizing Work Practices/ADVANCED

    DESIRED SKILLS

    Service/Providing Solutions to Constituent Needs/ADVANCED

    Telework Specifications:

    Telework considered only for current internal WAH (any area).

    ADDITIONAL JOB INFORMATION

    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.

    Benefit eligibility may vary by position. Click hereto review the benefits associated with this position.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care