Aetna Audit Manager - 52152BR in Walnut Creek, California

Req ID: 52152BR

**Full-Time Telework (WAH), prefer California resident but location is flexible to any location in the West Region

POSITION SUMMARY

This role is vital to the organization to ensure that Aetna's financial risk is mitigated by completing annual audits of Aetna's third party claims delegates to ensure the financial viability and stability of these delegated entities, and if necessary to recommend and obtain financial protection in the form of a letter of credit or performance bond. Also will work with California's Department of Managed Health Care to approve corrective action plans and to review Risk Based Organization's (RBOs) compliance with the DMHC's standards.

Fundamental Components:

  • Lower or eliminate Aetna's exposure to financial losses from delegated risk contracts (primarily California) with IPA's, medical groups and hospitals (providers) by performing annual desk reviews and onsite audits to assess the provider's financial viability.

  • Directly responsible for suggesting appropriate financial protections (i.e. letters of credit, guarantees, etc.) for those provider's who do not meet Aetna's strict compliance standards.

  • Will present audit findings monthly to the various Delegation Oversight Committees and recommend Corrective Action Plans when necessary.

  • Must develop and maintain strong working relationships with CFO's, Controllers, and Officers of the delegated providers in order to effectively assess their financial viability in a timely manner.

  • Most audits are desk reviews but must be willing to do occasional travel within California to audit a few providers. - Must be able to work independently, meet deadlines consistently and have an excellent knowledge of audit procedures and financial statement components.

  • Adhere to the highest standards of morale and ethical conduct and be able to work collaboratively with other internal areas such as Compliance, Legal, Finance and Network.

    BACKGROUND/EXPERIENCE desired:

    -Minimum of 4-7 years audit or related business experience (preferably within Health Insurance or related fields).

    -Project management experience.

    -Public Accounting experience highly desired

    -Finance, Accounting, Information Technology and/or Internal Controls experience preferred.

    EDUCATION

    Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Finance/Certified Public Accountant (CPA) is desired

    FUNCTIONAL EXPERIENCES

    Functional - Finance/Audit - financial reporting/1-3 Years

    Functional - Finance/Audit - compliance/1-3 Years

    Functional - Project Management/Communications Management/1-3 Years

    TECHNOLOGY EXPERIENCES

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

    Technical - Desktop Tools/Microsoft Outlook/4-6 Years/Power User

    Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/End User

    REQUIRED SKILLS

    General Business/Applying Reasoned Judgment/ADVANCED

    General Business/Communicating for Impact/ADVANCED

    General Business/Demonstrating Business and Industry Acumen/ADVANCED

    DESIRED SKILLS

    General Business/Maximizing Work Practices/ADVANCED

    Leadership/Driving a Culture of Compliance/ADVANCED

    Technology/Leveraging Technology/FOUNDATION

    Telework Specifications:

    Full-time telework (WAH), prefer California resident but location is flexible.

    #LI-EG1

    ADDITIONAL JOB INFORMATION

    Flexible telework position.

    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: Financial Services