Skip to main content

Senior Quality Consultant

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
Position Summary/Mission
Provides consultation on the quality of QNXT configurations for contracts, provider information, and health plans. 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 customers.

Fundamental Components:
Fundamental Components & Physical Requirements include but are not limited to:
Perform related duties as assigned by CSRA management, including but not limited to:
  • Completes all required quality activities required for the maintenance of existing health plans and implementation of new health plans.
  • Assists with performing focused audits when requested.
  • Identifies process improvements for the CSS or HPRA department for increasing work quality and reducing Remedy ticket TAT.
  • Represents CSS or HPRA as the quality process expert for various internal and external meetings as required.
  • Trains new staff as required to work in the CSS or HPRA QC group.
  • Maintains a 100% ticket target volume for SCR/IIF/Project QC assignment activities.
  • Provides Leadership/Coaching/Mentoring; to others on the CSS or HPRA team.
  • 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.
  • Conducts quality analysis on completed tickets and provides recommended configuration revisions and clarifications for solution documentation.
  • Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis.
  • Translates complex data into constructive data and information and makes recommendations.
  • Illustrates complex information in a clear concise manner through communication and job aids.
  • Provides workgroup support on projects.
  • Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.

Background Experience:
Background Experience Desired
  • 3-5 years of data interpretation and quality analysis experience.
  • Extensive experience with databases as well as interpretation and manipulation of related data.
  • Extensive experience with provider contracts, claims payments, and benefits.
  • Healthcare background.
  • Excellent verbal and written communication skills.
  • Excellent attention to detail and analytical skills.
  • Associate's degree, technical certification or equivalent work experience.

Additional Job Information:
This is a fast paced quality department supporting Configuration Solutions and Reimbursement Management. We are looking for a business professional who has strong attention to detail, clear communication, organizational, and analytical skills with experience evaluating quality. Claims processing or QNXT configuration experience is also a plus.

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

Desired Skills:
General Business - Maximizing Work Practices, General Business - Turning Data into Information, Service - Providing Solutions to Constituent Needs

Functional Skills:
Communication - Communication Quality Control, Products-Other - Medical

Technology Experience:
Aetna Application - BMC Remedy 7.5 Suite, Aetna Application - QNXT

Potential Telework Position:

Percent of Travel Required:

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.


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.