Aetna Analytics Senior Consultant - Medical Economics, Medical Expense Review in Plano, Texas
Req ID: 68189BR
**Flexible work/telecommute arrangement available for applicants with appropriate/relevant experience once training is completed.
We are seeking an analytical professional to join our Medical Economics - Medical Expense Review (MER) team. The primary goals of this team are to develop, interpret and favorably impact local market medical cost trend and provide analysis and network actions leading to medical cost improvement. This position will provide consultative support and medical cost based analysis of markets and network initiatives.
Fundamental Components included but are not limited to:
Analyze and research medical costs drivers. Support the development of scoreable action items by identifying outlier cost issues. Consult with network and clinical management on opportunities to improve company s discount position and strategic cost and utilization initiatives. Perform drill-down analysis to identify medical cost trend drivers; advise network of contracting opportunities to mitigate future trends. Own, track and document all aspects of related work from beginning to end of a project. Need experience with cost trends and analysis within Claims.
Qualifications Requirements and Preferences:
Applicants must have relevant analytical financial experience. An understanding of the healthcare industry is preferred. Familiarity with key managed care functions including provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials (underwriting, sales, product development, network management) is also strongly preferred. Minimum of 3-5 years experience in the managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product and benefits design. Advanced skills in Excel, MS-Access and Web-based query tools (data warehouse). Ability to learn new technologies. SAS Enterprise Guide experience preferred. Strong analytical ability and familiarity with advanced financial and healthcare concepts. Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective. Ability to manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and leadership in achieving results.
Additional Job Information:
Benefit eligibility may vary by position.
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.