Aetna Medical Economics Consultant in Philadelphia, Pennsylvania

Req ID: 43395BR

POSITION SUMMARY

The position will assist Medicare MEU team in identifying medical cost opportunities. This will include reviewing claims data, working with other business areas and performing root cause to reduce medical costs. The analysis will occur on HMO platform.

Fundamental Components:

  • Review HMO claim data with working in excel/access

  • Go to HMO platform to review opportunities and understand how claim processed and if it was paid correctly

  • Interact with other business areas and understand how to communicate and ask questions need

  • Represent MEU on calls in fixing opportunities

  • Be analytical in through process and able to explain in detail your findings

    BACKGROUND/EXPERIENCE desired:

  • HMO Claim system and/or processing needed

  • Strong Analytical background

  • Provider contracting and SCM

    EDUCATION

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

    FUNCTIONAL EXPERIENCES

    Functional - Claims/Claim processing - Medical or Hospital- HMO/4-6 Years

    Functional - Claims/Policies & procedures/4-6 Years

    Functional - Products-Medical/All Aetna Medicare Group Plans/4-6 Years

    Functional - Products-Medical/All Individual Medicare Plans/4-6 Years

    TECHNOLOGY EXPERIENCES

    Technical - Aetna Applications/HMO Claims Processing System/4-6 Years/End User

    Technical - Aetna Applications/Strategic Contracts Manager/4-6 Years/End User

    Technical - Aetna Applications/HMO Claims Processing System/4-6 Years/End User

    REQUIRED SKILLS

    General Business/Turning Data into Information/ADVANCED

    Leadership/Collaborating for Results/FOUNDATION

    General Business/Maximizing Work Practices/ADVANCED

    DESIRED SKILLS

    General Business/Applying Reasoned Judgment/ADVANCED

    General Business/Communicating for Impact/ADVANCED

    General Business/Ensuring Project Discipline/ADVANCED

    ADDITIONAL JOB INFORMATION

    Within this role you will be challenged to understand how our contracts, system, and policy work and be able to identify opportunities of medical cost savings.

    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