Aetna Quality Consultant in Orlando, Florida

Req ID: 45460BR


This position is accountable for the review and handling of Medicare Part D claim data. We use analytical and statistical techniques and tools to evaluate and influences enhancements to business processes and improve quality data.

Fundamental Components:

Use analytical and statistical techniques and tools to review/evaluate Medicare Part D claim adjudication and business processes.

Influence changes/enhancements to business processes and policies to improve the member experience.

Clearly and effectively expresses ideas both verbally and in writing that contributes to business success.

Integrates data from multiple sources into a logic framework that supports decision - making and provides root cause analysis.

Create communication strategies and presentations for both internal and external customers to educate and address continuous quality improvement initiatives.

Implements and validates improvements to work processes.

In partnership with business owners, support the design and development of new processes

Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous quality improvement initiatives.

Analyze and resolve complex claims scenarios within established time frames.


2+ years work experience in the audit environment that reflects a proven track record or proficiency in the competencies noted.

1 - 2 years Rx Claim experience a plus

Proven track record of Excellent communication skills; Verbal and Written

Ability to prioritize work load to meet the business needs

Analytical skillset:

Required Skills:

General Business/Applying Reasoned Judgment/FOUNDATION

Leadership/Collaborating for Results/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION.

Technology Experiences:

Technical - Desktop Tools/Microsoft Excel/1-3 Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User


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


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

Functional - Quality Management/Quality Management/1-3 Years

Functional - Customer Service/Customer Service - Pharmacy/1-3 Years

Functional - Communications/Employee communications/1-3 Years

Telework Specifications:

Full-Time Telework (WAH)

Considered for any US location

Percentage of Travel Required: 0-10%


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: Quality Management