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NonPar Medical Economics Consultant

Primary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell
To define, 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. Helps lead the production and analysis of medical cost information used to support NonPar, legal and legislative analyses.

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

Background Experience:
  • Demonstrates initiative, innovation and leadership in achieving results.
  • Demonstrates strong analytical ability, critical thinking, and expresses ideas clearly. Ability to manage conflicting priorities and multiple projects concurrently.
  • 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.
  • MINIMUM Intermediate in MS Excel and MS Access
  • MINIMUM Intermediate in SQL or SAS PREFERRED
  • Beginner/Intermediate Rumba applications (SCSR, EPDB) PREFERRED
  • Beginner/Intermediate Contract Pricing System or SCM experience

Additional Job Information:
We are expanding our department. Non-Participating provider reimbursement is an ever changing world which constantly adapts due to changes in the latest programs and legislations. New Surprise bill legislation is proposed and passed frequently at the state level (each with its own twist) as states tackle how to best help their residents. Additionally numerous pieces of Federal legislation has been proposed which we may see being passed in the future.
The preferred location is Blue Bell, PA, but we are open to other locations. 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, and legal analyses. This is a fast paced environment and the work is mostly ad hoc, though we always have several larger ongoing projects in the works. 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.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Turning Data into Information

Desired Skills:
Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Technology - Leveraging Technology

Functional Skills:
Finance - Financial reporting and analysis, Information Management - Statistical analysis, Medical Management - Medical Management - Medical Economics

Technology Experience:
Database - Microsoft Access, Desktop Tool - TE Microsoft Excel, Development Language - SQL

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)


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