Aetna Inc. Plymouth , MN 55447
This position will be the claims subject matter expert, with claim coding certification as well the primary resource for problem solving, program testing and analysis and input of data as required, for all areas within the claims operations unit. The position will also act as the technical liaison between the claims operations area and other areas within the company that affect operations day to day functionality.
Other areas of responsibility will include training, involvement in escalated issues as needed, documentation, etc. This position will assist ongoing in the analyzing of departments ongoing programming needs, recommend enhancements, etc and work with claims staff in the development of such enhancements, testing, documenting, upgrading, etc.
1.Medical claims code set expert responsible for validating and loading quarterly code sets from vendor, as well as assisting with coding projects.
2.Identify and implement process improvements through system enhancements or process re-engineering.
3.Assist in analyzing current operational procedures, identify problems and provide problem resolution support to staff as required.
4.Participation in operational projects as requested.
5.Create, update and testing of all documentation relative to new and existing processes and procedures
6.Works with programming staff as required reviewing system capabilities, current workflow, etc, in an effort to determine most efficient programming recommendations when needed.
7.Ongoing review of current online processes for efficiencies and effectiveness in all claims operations areas. Develops enhancements to improve workflow as appropriate.
8.Responsible for thorough testing of new developments and system enhancements related to claims processing, including training staff when necessary.
9.Resolve and respond to complex/escalated issues from clients both internally and externally as required.
10. Acts as liaison between claims operational areas and other departments within the company such as IT, etc.
11. Performs ad hoc reporting and analysis as requested.
12. Works on conversion and integration tasks relative to upgrades and acquisitions.
Certified coder with 5 years experience with coding projects
Strong leadership, planning, organizational, analytical, decision-making, and problem-solving skills.
Strong oral and written communication skills.
Self starter who is capable of working independently.
Ability to work effectively with and sell ideas to the various business units for improvement of workflow processes in the Claims department as well as throughout the company.
Ability to identify new and innovative solutions to meet business needs.
Strong analytical skills and ability to research and solve reporting discrepancies.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
General Business/Ensuring Project Discipline/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
General Business/Consulting for Solutions/FOUNDATION
General Business/Communicating for Impact/FOUNDATION
Technology/Selecting and Applying Technology Solutions/ADVANCED
Open up Job Rec to all locations. Internal or External candidates
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.
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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.