Aetna Claim Operations Analyst in New Albany, Ohio

Req ID: 52118BR

Telework considered only for locations within commuting distance to New Albany - OH, Harrisburg - PA, or Hartford - CT offices; training period in the office may be required

POSITION SUMMARY

The Claim Operations Analyst: 1) provides operational, financial and statistical analyses regarding medical insurance claim flow through Aetnas systems, 2) monitors operational metrics and researches metric variances, 3) performs quantitative and qualitative analyses regarding operational topics of interest, 4) responds to requests for information and analysis from internal department leaders, and 5) provides analysis and consultation to the teams that serve Aetnas members. The Analyst applies a combination of business knowledge of medical insurance claim operations concepts, and technical analytical skills, to gain insight into the state of claim operations.

Note: This is a business ANALYTICAL position, not an IT, systems analyst, application developer or report-generation position.

Fundamental Components:

  • Designs and executes analyses to respond to actuary and business leader questions regarding claim operational flows and their financial impact. Data includes professional and facility claim types, benefits, provider contract information, and claim adjudication information across multiple lines of business (Commercial Group, Medicare Advantage, Medicaid, etc.) and multiple systems.

  • Creates custom data sets and analysis of claim operational and financial data from many sources, answering business questions regarding the past performance and current state of claim operations. Analysis includes identification of operational and financial patterns in claim intake, disposition, payment, processing times, process performance, rework, and other business needs.

  • May perform applied statistical research, including predictive modeling, as well as custom quantitative analysis of healthcare claim operational data, interprets results; makes recommendations based on findings.

  • Presents results of analysis to clients and stakeholders.

  • Develops and delivers solutions, insights and business intelligence based on advanced analyses to support policy, benefits and operational decision making by Aetna internal and external constituents.

    BACKGROUND/EXPERIENCE desired:

    Three or more years of hands-on health economics or claim operations analytic experience.

    Demonstrated, applied knowledge of health care claim operational data, metrics, systems and standards.

    Well-versed in statistical model building and concepts, decision trees and classification rules, segmentation and cluster analysis.

    Must have experience creating and working with large data sets from multiple data sources, as well as working in a data warehouse environment.

    Must have knowledge of analytic programming tools and methods; Examples: must have strong skills using at least one of these applications: SAS, SAS Enterprise Guide, SQL, OLAP, Business Objects, Crystal. Our team uses SAS, SAS Enterprise Guide and SQL; analyst will be expected to code their own SAS or SQL projects.

    Must have strong Excel skills, including a command of Pivot Tables, formula construction and the use of Excel functions

    Experience using Word and/or PowerPoint is also preferred.

    Strong collaboration and communication skills within and across teams.

    Strong problem solving skills and critical thinking ability.

    Able to make sound decisions and recommendations to drive business solutions.

    Ability to clearly communicate statistical and technical ideas and results to non-technical clients in plain written and verbal form.

    EDUCATION

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

    FUNCTIONAL EXPERIENCES

    Functional - Information Management/Statistical analysis/1-3 Years

    TECHNOLOGY EXPERIENCES

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

    Reporting Tools/Business Objects/1-3 Years/Power User

    Development Languages/SQL/1-3 Years/Power User

    REQUIRED SKILLS

    Applying Reasoned Judgment/FOUNDATION

    Demonstrating Business and Industry Acumen/FOUNDATION

    Turning Data into Information/ADVANCED

    DESIRED SKILLS

    General Business/Consulting for Solutions/FOUNDATION

    Leadership/Collaborating for Results/FOUNDATION

    Technology/Leveraging Technology/ADVANCED

    Telework Specifications:

    Telework considered only for locations within commuting distance to New Albany - OH, Harrisburg - PA, or Hartford - CT offices; training period in the office may be required

    ADDITIONAL JOB INFORMATION

    The analyst will be joining a small team of professionals who are respected throughout Aetna for delivering excellent insight into business issues related to claim operations.

    We have a true team environment and are committed to developing each other. Each person has a unique set of skills and experience. We have a strong track record of employee development and career advancement. The work is interesting and challenging because the environment is always changing.

    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