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Claim Operations Analyst

Primary Location: New Albany, OH
Additional Locations: OH-New Albany
This position analyzes medical claim operations metrics across multiple lines of business and investigates a wide variety of questions regarding claim operational performance. The position requires both 1) business knowledge of Claim Operations concepts (including medical claim billing data elements, intake, inventory, adjudication, pricing, and payment) and 2) technical analytical experience developing data sets and independently performing operations analysis.

Fundamental Components:
The Claim Analytics Project Lead participates in all 3 primary activities of the department:
- 40% of time: Monitors assigned operations metrics, lines of business and special topics related to claim operations performance; Identify variances, and independently investigates questions regarding claim operational topics
- 40% of time: Responds to a variety of questions from business leaders concerning claim operations; design new metrics or methods for gaining deep insight into operational performance; creates written results of analysis in plain language for a wide variety of audiences; may present results to leaders
- 20% of time: Provide analysis and consultation for process improvement initiatives

Background Experience:
  • 3-5 years of data analysis experience using large data sets, including drawing conclusions and writing summaries
  • Solid understanding of medical claim data (terminology, claim structure and data elements)
  • Solid understanding of medical claim adjudication process (claim life cycle from intake to adjudication)
  • Excellent verbal and written communication skills.
  • Demonstrated ability to effectively coordinate multiple projects simultaneously.
  • Note: this is not a "report-generator" role. Although some reporting is required, the position primarily performs quantitative and qualitative analysis, and provides interpretation of changes in financial, operational and process flow metrics
  • Minimum 3 years experience using Excel to perform quantitative analysis using formulas, functions, pivot tables, charts
  • Experience building SAS (or similar) projects, Tableau visualizations, or 'big data' tools is a plus

Additional Job Information:
The position will be assigned a set of responsibilities for monitoring and detection of variances. Examples include changes in incoming volume of dollars, increased level of rejected claims, claim auto-adjudication rates, claim inventory levels (counts and billed charges), age of inventory or payment flows, rework levels and others.

Our department functions as a true team: colleagues frequently work together as part of their daily routine, learn from each other, assist each other, cover each others' assignments, and contribute to each others' success. Collaboration is an integral part of daily work. Colleagues are expected to continuously learn and grow in their positions.

The ideal candidate will be self-motivated, have an inquisitive mind, be a creative problem solver and be willing to help others. Our team members hold themselves to the highest standards of ethical conduct.

Clinical Licensure:

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.

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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