Aetna Claim Reporting and Special Services Analyst in Fresno, California

Req ID: 40026BR

POSITION SUMMARY

Are you looking to join a team truly making a difference? This may be just that job as we are looking for individuals who truly out the member at the center of everything they do. Our Rework Analysts handle claims not processed correctly the first time and play a critical role for our members who are impacted every time we touch a claim.

We are looking for highly motivated candidates who are self-driven, collaborative, possess strong ACAS claim processing skills, and some experience with claim rework. Candidates must be able to analyze project and/or individual rework claims for root cause errors, work across teams to correct those errors, and reprocess the claims. In addition, candidates must be detail-oriented, quality minded, able to recognize trends, be a team player, and meet expected results.

Fundamental Components:

Responsibilities include:

  • Identifying the true root cause of improperly handled claims and keeps asking "why" to get to the true root cause of errors

  • Communicate as needed to correct issues causing claims to be handled incorrectly

  • Professional written and verbal communication

  • Accurately reprocess claims not handled or adjudicated correctly

  • Provide feedback as needed within and outside team

  • Balance work volumes to meet expected turnaround times

  • Work collaboratively for individual and team results

  • Complete required trainings timely

  • Meet minimum expected results for the position (E.g., productivity standard, quality metric, etc.)

  • Own personal development and career path

    BACKGROUND/EXPERIENCE desired:

    The ideal candidate will:

  • Have a minimum of 1 year of ACAS claim processing experience.

  • Proactively identify and trend issues.

  • Have a working knowledge of EPDB provider knowledge.

  • Possess strong teamwork and organizational skills.

  • Analyze data (moderate experience with Excel)

  • Strategic Contract Manager pricing a plus

    EDUCATION

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

    FUNCTIONAL EXPERIENCES

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

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

    TECHNOLOGY EXPERIENCES

    Technical - Aetna Applications/Electronic Workflow Manager/1-3 Years/End User

    Technical - Aetna Applications/Customer Coverage Inquiry (web)/1-3 Years/End User

    Technical - Desktop Tools/Microsoft Foundation Classes/1-3 Years/End User

    REQUIRED SKILLS

    General Business/Maximizing Work Practices/MASTERY

    Leadership/Driving a Culture of Compliance/ADVANCED

    Service/Demonstrating Service Discipline/FOUNDATION

    DESIRED SKILLS

    Leadership/Creating Accountability/FOUNDATION

    Service/Working Across Boundaries/FOUNDATION

    Leadership/Collaborating for Results/FOUNDATION

    Telework Specifications:

    Considered only for current internal teleworkers (in any area)

    ADDITIONAL JOB INFORMATION

    Aetna recognizes employees as our most valuable asset. And along that mindset, we are committed to helping to develop employees to reach their full potential and grow with career opportunities. This position will report to the Claim & Provider Solutions (CPST) Project and Rework Team and will support all provider network territories, nationally contracted providers as well as rework for Legal/ Regulatory/Compliance, Plan Sponsors and systemic issues. At times individuals are asked to cross-train and shift assignments as needed to support our customers. We are looking for a strong candidate to join our team. We offer a flexible work schedule and work together to meet the needs of our customers. We also present learning opportunities when possible to help develop our staff looking to advance their career at Aetna.

    This position is a great opportunity for those interested in expanding their knowledge with cross-functional teams.

    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: Claim