Aetna Medical Economics Consultant - Medical Cost NonPar in Blue Bell, Pennsylvania
Req ID: 54745BR
On the NonPar team, there is a real opportunity to not only understand, but impact medical costs. As part of the larger Medical Economics Unit (MEU) you will have daily exposure to other teams within the department as well as teams outside of MEU. Wedefine, develop, and provide information and analyses to drive the decision-making process and support business operations for internal and external customers with respect to reporting and controlling medical cost of services provided to members. You will help lead the production and analysis of medical cost information used to support NonPar and legal analyses.In this role you will gain an in depth knowledge of NonPar claims. Some of the topics include: National Advantage Program (NAP), plan benefit design, high cost provider analyses, and Non Par legislation. Another key role will be providing in depth analyses to the legal department in support of ongoing and future litigation. This is a fast paced environment and the work is mostly ad hoc, though we always have several larger ongoing projects in the works. Fundamental Components:
Applies technical and analytical skills to analyze NonPar projects. Provides analyses for in-depth legal requests supporting litigation and legislation. Serves as project manager and/or participant on selected project(s). Develops information in support of strategic business plans to meet projected requirements of business area. Works cross-functionally to support various on internal customers. Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives. Can scope out projects and make recommendation for next steps.
Minimum of 2-5 years experience in medical cost analysis and in the managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product and benefits design. Ability to learn new technologies. Demonstrates strong analytical ability, critical thinking, and expresses ideas clearly. Ability to manage conflicting priorities and multiple projects concurrently.
MINIMUM Intermediate in MS Excel
MINIMUM Intermediate in MS Access
MINIMUM Intermediate in SQL or SAS REQUIRED basic understanding of statistics
PREFERRED Beginner/Intermediate SCSR
PREFERRED Beginner/Intermediate EPDB
PREFERRED Beginner/Intermediate Contract Pricing System or SCM experience
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Medical Management/Medical Management - Medical Economics/1-3 Years
Functional - Information Management/Statistical analysis/1-3 Years
Functional - Finance/Financial reporting and analysis/1-3 Years
Technical - Database/Microsoft Access/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/Power User
Technical - Development Languages/SQL/1-3 Years/End User
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Turning Data into Information/ADVANCED
General Business/Communicating for Impact/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Flexible telework / office-based schedule (can live near any office location)
ADDITIONAL JOB INFORMATION
The preferred location is Blue Bell, PA, but we are open to other locations.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.