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Senior Claims Auditor

Primary Location: Franklin, TN
Additional Locations: TN-Franklin
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Description:
Performs quality audit for service operations for multiple products and platforms.

Fundamental Components:
Conduct standard quality reviews/audits to measure compliance with published policies, procedures, customer and regulatory guidelinesIdentify and distribute errors to business partnersSubject matter expert on workflows, policies, systems requirements/enhancements daily operations and programsPerform root cause analysis and/or analyze data to identify and communicate trends in day-to- day work (e.g., quality of results, efficiencies of processes, etc.)Responsible to support targeted quality audit projects. Report results and make recommendations e.g., training needs, quality controls and procedures, etcConduct specialized audits as requested to monitor and track customer and regulatory requirements Provides workgroup support to projectsMay provide guidance or expertise to less experienced quality analysts Assist with the day-to-day maintenance and operations of assigned functional unitUnder general supervision, perform more complex aspects of the various audit disciplinesMay report and forecast inventory and business activity results Recommend ideas for the development of quality control policies and procedures of own unit in the performance of specific job functionsAdminister business procedures ensuring compliance requirements are satisfied

Background Experience:
Intermediate/Advanced proficiency in office technology. Basic project management skills. 2-5+ years experience in an audit environment that reflects a proven track record or proficiency in the competencies noted. Life or Ancillary products a plus. High school diploma or equivalent.

Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact

Desired Skills:
Leadership - Driving a Culture of Compliance, Leadership - Driving Change

Functional Skills:
Claim - Claim processing - Life, Claim - Claim processing - Medical - Medicare, Claim - Policies & procedures

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by 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.

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