Aetna Project Lead in Hartford, Connecticut

Req ID: 50311BR

POSITION SUMMARY:

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 data analytics team which is accountable for application development and support, regulatory reporting, and data mining techniques to uncover patterns of fraud, waste or abuse within claims data.

Fundamental Components:

The SIU data analytics team is looking for a data driven individual who is consistently looking to create efficiencies through automation and improve existing processes using new technology. The ideal candidate would have a solid understanding of relational databases, medical and pharmaceutical claim data, as well as SAS/SQL coding; basic Mainframe and Tableau experience preferred but not required.

The position will provide the right candidate the opportunity to utilize a wide range of analytical, reporting and programming skills while contributing to the fight against healthcare fraud. We are a highly motivated and dedicated team that values each others 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 group settings as well as interacting with customers from all levels of the organization.

Create complex queries, including technical reporting and programming.

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 departments and cross functional areas to understand and facilitate data requests.

Understand nuances of data, check for reasonability, and work to improve data quality.

Knowledge of advanced analytics tools and languages to analyze large data sets from multiple data sources.

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

May lead or act as a business technical contact in the design of new applications 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 and external customers providing recommendations based on business knowledge. This position will also be responsible for the creation and timely submissions of all regulatory reporting related to fraud waste and abuse activities.

BACKGROUND/EXPERIENCE desired:

Advanced knowledge of Tableau, SQL, SAS, Excel and Access. required. Ability to make sound decisions & recommendations. 5+ years of health research, including knowledge of health care data (CPT, HCPCS and ICD codes), metrics, systems & standards preferred but not required. Experience with Statistically Valid sampling and extrapolation preferred but not required. Ability to work in a team environment & independently manage workload/deliverables is required. Ability to effectively communicate findings identified in the data to internal and external customers. Experience with regulatory reporting preferred. Medicaid and/or Medicare experience a plus.

EDUCATION:

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

FUNCTIONAL EXPERIENCES:

Information Management/Data acquisition, data management, programming and documentation/4-6 Years

Information Management/Database Structures/1-3 Years

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

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

Information Management/Informatics/4-6 Years

TECHNOLOGY EXPERIENCES:

Reporting Tools/SAS/1-3 Years

Reporting Tools/SAS MACRO/1-3 Years

REQUIRED SKILLS:

General Business/Consulting for Solutions

General Business/Turning Data into Information

Technology/Leveraging Technology

DESIRED SKILLS:

Communicating for Impact

General Business/Maximizing Work Practices

Leadership/Driving a Culture of Compliance

Telework Specifications:

Work at home. Considered for any US location; training period in the office may be required

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: Health Care