Aetna Senior Quality Consultant in Amherst, New York
Req ID: 50796BR
Accountable for review and/or handling of quality complex audits for benefit administration company.In this role the successful candidate will primarily focus on auditing of health plan documents, including summary plan descriptions (SPD), plan amendments and Summary of Benefits and Coverage (SBC) for self-funded plans to measure compliance with published policies, procedures, customer and regulatory guidelines.
Develop and implement quality assessment/audit/measurement programs tailored to plan document drafting team.
Create strategies to educate and address continuous quality improvement opportunities.
Identify and establish internal and external benchmarks for performance evaluation to include standards, procedures and corrective actions to be followed.
Influence changes/enhancements to business processes, policies, and system infrastructure to improve quality of documents being produced by the plan document drafting team.
Develop and design data collection capability (e.g., customer surveys focus groups, system reports) and develop appropriate measures.
Analyze customer feedback and other measures of quality.
Analyze data for trends, highlights in-depth interpretations and provides in-depth root cause analysis of findings.
Provide regular employee coaching and mentoring based on analyzed data.
Creates and updates training documentation such as training outlines, manuals, job aids and other materials.
Coordinate, schedule and facilitate the development of training for new and existing team members. May deliver advanced training and may provide guidance or expertise to plan document drafting team.
3 5 years Experience in an audit/quality review environment.
Experience with Third Party Administration and Self-Funding supporting custom health insurance products and/or services.
Demonstrates critical thinking and analytical ability.
Demonstrates ability to train others by sharing knowledge.
Effective time management, organizational and prioritization skills.
Regarded as approachable.
Demonstrates aptitude to develop people and processes.
Plan drafting experience supporting self-funded or fully insured plans.
Strong attention to detail and accuracy performing at high levels in a fast paced and constantly changing work environment.
Ability to give and receive constructive feedback.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Administration / Operations/Document production & distribution/1-3 Years
Functional - Communications/Communication Quality Control/4-6 Years
Functional - Customer Service/Customer Service - Plan Sponsor - Contract installation & maintenance/1-3 Years
Functional - Quality Management/Quality Management/4-6 Years
Functional - Sales & Service/Self insured/stop loss products/4-6 Years
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/Power User
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.
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