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Job Information

Aetna Claims Quality Consultant in Sandy, Utah

Req ID: 61960BR

Job Description

Responsible for complex quality audits and projects, etc associated with the unit s functional focus.

Fundamental Components included but are not limited to:

Subject matter expert on workflows, policies, components of systems and on daily operations and programs Use analytical and statistical techniques and tools to plan and perform research and analysis of processes (e.g., outcomes performance guarantees, government regulations, and customer requirements, etc.) to recommend enhancements and workable solutions by cost benefit analysis Responsible to support targeted quality audit projects. Report results and make recommendations e.g., training needs, quality controls and procedures) In partnership with business owners, support the design and development of new processes Develop and implement quality programs and initiatives. Participate in the development and validation of master or detail test plans and strategies. Under direct supervision, develop and deliver training. May provide guidance or expertise to quality staf. Facilitate team sessions to develop processes and/or resolve issues. 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 Identify and recommend internal and external benchmarks and appropriate measures for performance evaluation. May, under supervision, develop quality assessment/audit/measurement programs tailored to specific assignments Analyze customer feedback and other measures

Qualifications Requirements and Preferences:

3 - 5+ years work experience in claims processing and audit environment that reflects a proven track record or proficiency in the competencies noted. High school diploma or equivalent.

Functional Skills:

Claim - Payment management, Claim - Quality management

Required Skills:

General Business - Communicating for Impact, General Business - Turning Data into Information, Service - Creating a Differentiated Service Experience

Additional Job Information:

Must be detail oriented, have good written and verbal communication skills and put together meaningful summaries and presentations as required.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Quality Management

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.