Aetna Quality Analyst in Amherst, New York
Req ID: 54842BR
The Eligibility Audit process reviews work of Eligibility and COBRA Specialists to validate they are entering transactions correctly into the processing system(DG). This includes eligibility transactions sent by paper, electronic files, and entered by the client via the web. Transaction accuracy is evaluated using internal procedures, plan documents, industry standards, and government compliance documentation. Errors and results are communicated to the Eligibility Specialist and Supervisor. Monthly error analysis reports are created and shared with Eligibility management to evaluate individual and Eligibility team performance.
Producing accurate and complete audit results with an understanding and concern for the steps and tasks involved in the process being audited.
Follow stated internal procedures, conduct research, obtain clarification of information, to ensure that all decisions made take into account the expected outcome and the effect decisions and actions have on other processes.
Create and maintain appropriate documentation to provide timely feedback of audit results and identification of trends.
Identify, document, and report compliance issues with respect to industry standards, state and federal guidelines.
Teamwork is an essential component of this position due to the need for collaboration with other departments to resolve issues and deliver optimal results for our clients.
Prior auditing experience a plus
Knowledge of the DG, WEX, and other Meritain processing systems preferred
Basic knowledge of Excel
Attention to detail
Effective and professional written and verbal communication skills
Strong investigative skills
Ability to interpret Plan Document language
Ability to multi-task and set appropriate priorities
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
ADDITIONAL JOB INFORMATION
This position provides an opportunity to make a difference for our clients by ensuring adherence to processes and procedures, industry standards, and government regulations, as well as to our members by ensuring their benefit elections are accurately resulting in accurate processing of their claims. We also bring attention to trends and emerging issues for process improvement and training purposes. Our ideal candidate will have a varied background in a TPA/self funded environment with strong medical/dental claim processing knowledge. Previous auditing experience would be a bonus. We need people that are team players and can work independently with minimal supervision.
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 candidates'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: Quality Management
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.