Aetna Network Consultant in Chicago, Illinois

Req ID: 41709BR

All candidates are required to work from the Chicago, IL office full-time.

POSITION SUMMARY

The Network Consultant position supports the Provider Relations team by ensuring integrity of provider data in company QNXT, responding to provider inquiries via phone, and researching initial provider issues. The Network Consultant also collaborates with Network Account Managers to help address operational issues in the providers relationship with the health plan.

Fundamental Components:

Performs plan set-up activities and on-going maintenance of claim systems ensuring proper adjudication against the established benefit plan parameters, including plan conversions resulting from changes to claim systems platform.

Performs root cause analysis of items that might hinder claim system efficiency (i.e., system edits/pends); identifies opportunities to improve and increase auto adjudication rates.

Knowledge of Disputes, and appeal claims.

BACKGROUND/EXPERIENCE desired:

High School Diploma

Knowledge of managed care business and healthcare environment.

Prior healthcare experience preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Claims/Associate in Claims (AIC) is desired

FUNCTIONAL EXPERIENCES

Claims/Claims Administration - cost management/1-3 Years

Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years

Claims/Claim processing - Medical - Behavioral Health/1-3 Years

TECHNOLOGY EXPERIENCES

Microsoft Word/1-3 Years/Power User

Microsoft Outlook/1-3 Years/Power User

ADDITIONAL JOB INFORMATION

Has previous experience in claims disputes, and appeals and Grievances.

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 here to 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