Aetna Claims Reporting Analyst in Houston, Texas

Req ID: 43722BR

POSITION SUMMARY:

The individual must be able to create and run claim reports in ORS, Open Span or Data Warehouse. The individual must have a strong background in claims and be able to assist analysts with resolution of problems involving research into policy data, claim or commissions systems. They must be able to identify, research, develop, and recommend solutions to problems/issues.

Fundamental Components:

Independent resolution of all problems. Assist analysts with resolution of problems involving research into policy data, claim or commissions systems. Identifies, researches, develops, and recommends solutions to problems/issues. Expert in the primary system(s) used by the unit (ACAS, ASD, ATV, Excel, ). Assist analysts with processing complex/sensitive customer transactions and correspondence. Assist with analyzing and the resolution of error conditions requiring system research. Participate/leads project teams, influences areas outside of direct control. May represent Aetna to outside organizations. Determine solutions, both work flow and system, for new products, processes and procedures. Interpret specific state laws and other legal regulations and ensures that system and procedures are enhanced or modified to keep Aetna in compliance with all requirements. Processes or assists analysts with complex and/or sensitive customer transactions in appropriate systems. Reviews all management level reports for validity, accuracy and trends. Ensures internal as well as external financial transactions associated with unit functions are appropriately applied. Monitors and reviews designated system activity and proactively leads investigation of discrepancies and trend fluctuations. Provides support for the analysis of financial results for commissions, claims or reinsurance in order to meet closing schedules and/or respond to customer inquiries. Conducts training programs on systems and service functions for new and existing staff. Maintains documentation of unit procedures. Makes presentations to peers and customers (internal and external).

BACKGROUND/EXPERIENCE desired:

Must have a minimum of 5 years experience using Automatic Claim Adjudication System (ACAS). One or more years of data analysis experience, knowledge of healthcare and/or dental claims preferred. Demonstrated analytical and problem-solving skills.

EDUCATION:

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

FUNCTIONAL EXPERIENCES:

Functional - Claims/Claim processing - Dental/1-3 Years

Functional - Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years

Functional - Claims/Reporting & special services/1-3 Years

Telework Specifications:

Full-Time Telework (WAH)

Flexible telework / office-based schedule (can live near any office location)

ADDITIONAL JOB INFORMATION:

The individual must be able to create and run claim reports in ORS, Open Span or Data Warehouse. The individual must have a strong background in claims and be able to assist analysts with resolution of problems involving research into policy data, claim or commissions systems. They must be able to identify, research, develop, and recommend solutions to problems/issues.

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