Aetna Senior Project Manager in Arlington, Texas
Req ID: 48877BR
As part of the NextGen Platform Development team, this position will translate and configure Provider and Network features to support the many functions within the NextGen administrative platform. Accurate provider configuration will help drive speed to market for new and changing product offerings, accurate claims adjudication, and satisfied consumers. By working closely with other areas of the company such as claims, network, product, legal/compliance, medical policy, and/or segment leaders to ensure the correct decisions are made when configuring provider demographics. This position will manage multiple projects concurrently and requires the ability to keep all efforts moving toward resolution in a timely manner. Excellent communication skills, both written and verbal, are required as this position will need to clearly communicate across all levels of the organization.
Responsible to ensure specific provider demographic data for Aetnas NextGen products are configured accurately and timely to drive a positive consumer experience. Review new and existing provider demographic data to determine the most effective programming methodology to facilitate accurate and consistent claim adjudication. Assist with the development of provider rules within configuration to support claims adjudication and provider contract load. Document decisions made during configuration to use as a reference for future builds. Work collaboratively with internal/external constituents on quality reviews, audits, and test plan(s) execution. Use analytics to validate data accuracy, identify potential gaps, and develop and manage implementation of corrective actions. Identifies and appropriately escalates data transaction issues that could potentially have significant contractual implications or adversely impact service levels. Partners with outside vendors to review and assess impact of configuration needs to effectively manage potential implications of complex provider set-up and contractual arrangements. Complies with the laws, regulations and ethical standards that govern the business.
Proven track record in meeting project milestones and negotiating for resources.
Proven communication skills both written and verbal
Past experience includes development of budgets
Past positions required acting a project lead and directing a team
Proven ability to affect change/interpersonal skills
Solid Project Management and supervisory skills
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Project Management/Project Leader/
Project Management/Cross-functional project management/
Management/Management - Process and quality improvement/
Aetna Applications/Enterprise Provider Database System/7-10 Years/System Support
Database/Intuit QuickBase/4-6 Years/Power User
Leadership/Collaborating for Results/ADVANCED
Leadership/Developing and Executing Strategy/ADVANCED
General Business/Applying Reasoned Judgment/MASTERY
General Business/Communicating for Impact/ADVANCED
General Business/Ensuring Project Discipline/MASTERY
This position can be located anywhere in the US and potential for telework.
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 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: Management