Aetna Reporting Project Lead - 56081BR in Fresno, California

Req ID: 56081BR


The Aetna Special Investigations Unit is responsible for the detection, investigation, and prevention of all suspected cases of healthcare fraud. The Project Lead position resides within our Systems & Reporting team which is accountable for application development and support, reporting, and data mining techniques to uncover patterns of fraud, waste or abuse within claims data.

Fundamental Components:

The SIU Applications & Reporting team is looking for a data driven individual that can analyze big data and create a story through data aggregation and reporting. The ideal candidate would have a solid understanding of medical and pharmaceutical claim data, experience as a business developer in Tableau to create and maintain internal dashboards, trends and metrics and SAS/SQL coding experience.

Job responsibilities include:

•Create and communicate messages based on available data from real-time analyses, including preparing easy-to-understand charts, tables, graphs, and other related documents for diverse audiences.

•Validate reports and deliverables for accuracy and timeliness per specifications and workflows.

•Meet with other plan departments and cross functional areas to understand and facilitate reporting requests.

•Understand nuances of data, check for reasonability, and work with team members to improve data quality.

•Knowledge of analytics tools to analyze large data sets to identify trends,spikes or anomalies within the data

•Influence changes/enhancements to business processes, policies, and system infrastructure to improve information.

•May lead or act as a business contact in the design of new reporting dashboards or enhancements.

This position offers a wide variety of healthcare analytics, performing all aspects of data analyses, research and reporting for both internal and external customers. Identification and resolution of data issues Interprets, analyzes and presents key findings to internal customers providing recommendations based on business knowledge.


Working knowledge of creating Tableau dashboards, advanced experience in Excel and Access, knowledge of SQL and/or SAS. Ability to find creative solutions,make sound decisions & recommendations. 5+ years experience with healthcare data, metrics, and reporting. Ability to work in a team environment & independently manage

workload/deliverables is required


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Functional -Information Management - Database Structures/1-3 Years

Functional -Project Management - Issue identification and analysis/4-6 Years

Functional -Information Management - Query and Database Access Tools/4-6 Years

Functional -Information Management - Business information analysis/4-6 Years


Technical- Reporting Tools - Base SAS/1-3 Years/Power User

Technical - Reporting Tools - Tableau/Working Knowledge


General Business/Consulting for Solutions/ADVANCED

General Business/Turning Data into Information/MASTERY

Technology/Leveraging Technology/ADVANCED


General Business/Applying Reasoned Judgment/MASTERY

General Business/Communicating for Impact/MASTERY

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

Full-time telework (WAH) considered for experienced candidates; office-based employee could have part-time telework option



This position will provide the right candidate the opportunity utilize a wide range of analytical and reporting skills to help uncover schemes and sources of fraud, waste and abuse; thus contributing to the fight against healthcare fraud. The costs of healthcare fraud, waste, and abuse are estimated to be anywhere between 3% and 10% of the total healthcare spend which equates to several billion dollars annually. We are a highly motivated and dedicated team that values each other s opinions and are always willing to share with and learn from one another. The Special Investigations Unit is a high performing, forward facing unit that interacts with multiple internal and external customers on a regular basis. Candidates should feel comfortable sharing findings within internal group settings as well as occasionally interacting with customers from different levels of the organization.

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: Health Care

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.