Sr Eligibility Consultant

Aetna Inc. Lawrenceville , GA 30046

Posted 5 days ago

Job Description:


Processes accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production (e.g., ID cards, billings, mailings, etc.). Ensures services and products meet the plan sponsors needs.

Fundamental Components:

Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. (*)

Delivers consulting services in support of data discrepancies and/or involving reporting alternatives. (*)

Responds to eligibility and other enrollment related issues involving member specific information; partners directly with clients, vendors, field marketing staff, and/or local claim operation to resolve problems and achieve positive outcomes. (*)

Assists with and/or evaluates recommendations involving electronic eligibility reporting solutions and negotiates with internal/external clients. (*)


Prefer 2-4 years data analyst experience

Attention to detail and accuracy.

Problem solving skills.

Understands the impact of work to other teams and downstream support areas.

Ability to analyze and research data to make appropriate corrections as necessary.

Sound understanding of system/data errors and how to resolve efficiently.

Strong organization skills.

Strong verbal and written communication skills.


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


Technology/Leveraging Technology/ADVANCED

General Business/Communicating for Impact/ADVANCED

Leadership/Anticipating and Innovating/MASTERY


Leadership/Collaborating for Results/MASTERY

General Business/Maximizing Work Practices/MASTERY

Leadership/Creating Accountability/MASTERY

Telework Specifications:

Option for telework will be evaluated after a certain period of employment


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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Regional Marketing Consultant

Advanced Dermatology

Posted 5 days ago

VIEW JOBS 3/15/2019 12:00:00 AM 2019-06-13T00:00 The Regional Marketing Consultant, promotes the company's dermatology and cosmetic services to decision makers within key physician practices and other areas that present opportunities as defined by the marketing plan, thereby resulting in increased referrals to the practice. Experience * Minimum of 3 years of proven healthcare/business-to-business sales experience * Previous experience in a dermatology setting preferred Essential Job Duties and Accountabilities * Contribute to an annual sales plan/budget by increasing referrals to the practice. * Prospect new business and maintain existing business on a daily basis to increase the referral source base and diversity of the referral sources within a territory. * Achieve and maintain cold calls and in-person visits with decision makers. * Conduct frequent referral source in-services as part of the educational component. * Provide superior customer service and information to referral sources in order to obtain and maintain business. * Establish a strong understanding of the competitors of ADCS. * Provide ongoing communication between the referral sources, managers, and physicians, as needed. * Promote ADCS mission and values statements through marketing efforts. * Identify changes in the industry, and competitive advantages, in order to incorporate changes within the organization. * Provide ongoing communication regarding satisfaction/feedback from patients and referral sources. * Maintain a sufficient supply of sales literature, educational information, etc., in a clean and presentable condition necessary to effectively promote the organization's products and services. * Actively participate in weekly/monthly conference calls and other meetings as appropriate; * Participate in other special projects or sales-related activities, etc. * Maintain knowledge of, and compliance with, HIPAA standards, and adherence to healthcare compliance policies. * Utilize excellent interpersonal skills and experience in building long term relationships. * Skillfully apply understanding of a sales cycle to a designated territory. * Manage designated accounts and expand the marketplace. * Utilize excellent presentation skills as well as proficient organizational and time management skills; * Perform other duties as assigned. REPORTING RESPONSIBILITIES: * Responsible for completing the following reports: Weekly Calendar, Expenses (weekly), and other reports required by management. * Responsible for maintaining activity reports. * Work within the assigned expense budget by exercising sound judgment with regard to general operating, travel, and entertainment expenditures Compensation/ Benefits * Benefits packages * PTO/6 Paid Holidays/Floating Holiday/Vacation Time * 401K ADCS Clinics LLC participates in equal employment opportunities for all individuals and abides by EEOC and nondiscrimination provisions of all applicable federal, state, and local laws and regulations. All applicants must have authorization to work in the United States. Advanced Dermatology Lawrenceville GA

Sr Eligibility Consultant

Aetna Inc.