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Senior Consultant Complaints

Primary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell
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Description:
Provides consultation on the design, testing and enhancement of information product including technical assistance and product development support to external and internal customers. Researches, manipulates and prepares complex data to document program activities and reports on its results. Provides oversight to data quality and provides feedback to various areas in order to improve service delivery and enhancement to design efforts. Develops a consultative relationship with internal/external customers.

Fundamental Components:
  • May lead or act as a business technical expert with the planning, development and validation of master or detail test plans and strategies.
  • Performs ongoing research, and support tasks for existing systems.
  • Leads or acts as a business technical expert in the design of new applications or enhancements including integration of solutions.
  • Provides Leadership/Coaching/Mentoring; may be a mentor to others.
  • Directs the implementation of program specific information through education, technology, organizational methods and procedures.
  • Influences enhancements to business processes and system infrastructure to improve data quality availability and access.
  • Manages customer contact and participates in internal and external health industry development efforts (e.g., performance measurements).
  • Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis.
  • Consults with client on a regular basis to ensure progress is in line with customer's expectations and to obtain additional information as needed.
  • Translates complex data into constructive data and information and makes recommendations.
  • Defines, identifies, develops and implements information products to support strategic business and operational planning.
  • Illustrates complex information in a clear concise manner.
  • Develops and conducts presentations and consultations to existing and prospective customers and internal business areas.
  • Provides workgroup support on projects.
  • Educates customer on the value, use and interpretation of information product.
  • Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.
  • Evaluates available software and data to deliver better business solutions.
  • Use knowledge, team resources, and data from multiple source systems to perform root cause analysis on complaints.
  • Clearly document root cause drivers and ensure internal customers understand what is causing complaints.
  • Analyze complex data to identify trends and risk mitigation plans.
  • Differentiate between data that is relevant and/or critical and data that is not.
  • Identify opportunities for process improvement and recommend changes to business partners.
  • Drive improvements to work processes and validate that changes were completed as expected.
  • Collaborate on projects throughout the Medicare organization.


Background Experience:
  • Excellent verbal and written communication skills.
  • Extensive experience with databases as well interpretation and manipulation of related data.
  • Healthcare background.
  • 3-5 years of data interpretation and analysis experience.
  • Bachelor's degree, technical certification or equivalent work experience.


Additional Job Information:
Functional Claims
Claim Processing Medical Medicare
Policies & Procedures
Claim Processing- Dental
Enrollment Functional Knowledge Medicare

Technical
IDX Systems
Burgess Pricer
Strategic Pricer
Complaints & Appeals Tracking System
NextGen
Pegasus
EPDB
Navigator
ATV
Microsoft-PowerPoint, Excel, Word

Required Skills:
General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen, General Business - Ensuring Project Discipline

Desired Skills:
General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Leadership - Driving Change

Functional Skills:
Claim - Claim processing - Medical - Medicare

Potential Telework Position:
Yes

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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