Aetna Analyst - Pharmacy Coordination in Hartford, Connecticut
Req ID: 43228BR
Highly preferred: In office position in Hartford, CT, Harrisburg, PA, or Arlington, TX
Open to telework in any location
We have an exciting opportunity on the Pharmacy Eligibility & Coordination of Benefits (COB) team for a qualified individual to use and develop Aetna Core Competencies while contributing to our team and Aetnas success. This position involves research and resolution of Pharmacy COB inquiries; collecting and analyzing data to make order of benefit determinations; identifying and reacting to trends; and collaboration with a variety of internal and external areas. Outbound calls to other insurance companies and CMS (Centers for Medicare & Medicaid Services) are also a routine part of the job. Working independently is critical to the success of this role, as well as working collaboratively with the rest of the team.
Receive, triage, research and resolve Pharmacy COB inquiries in an accurate and timely manner Review, collect and resolve conflicting, missing or inaccurate pharmacy benefit information via telephone, email and written correspondence. Communicate clearly and concisely with internal customer service representatives, plan sponsor liaisons, other insurance providers and Medicare to collect information and resolve complex coordination of benefit issues Effectively analyze and interpret information collected to make order of benefit determinations using Medicare Secondary Payer and NAIC (National Association of Insurance Commissioners) order of benefit determination guidelines Update member files in appropriate systems to reflect accurate coordination of benefits Use tools and queries to generate reports, analyze data, identify recovery opportunities and forward data to vendor to obtain recovery Create and follow detailed Policy and Procedure guidelines for all facets of job responsibilities, as needed Ability to effectively prioritize multiple assignments to meet turn-around-times while meeting or exceeding quality review standards on internal audits Focus on problem-solving and thorough resolution of complex issues Early identification of recurring COB issues/trends (either individual or group-wide) and ability to escalate issues/trends to appropriate level by providing clear communication accompanied by examples of the issue/trend Be open and enthusiastic to change; embrace new technology/processes
Experience in data research and analysis. Health care industry experience. Working knowledge of Microsoft Office products (Word, Excel, MSAccess, PowerPoint, Outlook, Project). Excellent verbal and written communication skills
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Pharmacy/ is desired
Claims/ is desired
Healthcare Management/ is desired
Customer Service/Associate Customer Service Specialist is desired
Functional - Customer Service/Customer Service - Pharmacy/1+ Years
Functional - Claims/Claims Administration - coordination of benefits (COB) verification/1+ Years
Technical - Aetna Applications/Pharmacy RxSy Suite/1+ Years/End User
Technical - Database/Microsoft Access/1+ Years/End User
General Business/Communicating for Impact/ADVANCED
General Business/Turning Data into Information/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
Service/Providing Solutions to Constituent Needs/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Considered for any US location; training period in the office may be required
ADDITIONAL JOB INFORMATION
We have staff on-site in Harrisburg, PA and Arlington, TX. Candidates in those locations would benefit from face-to-face training; however, the position can be telework in any location. We're a high performing team that thrives in a virtual environment, keeping a focus on the member experience in every issue.
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