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Negotiator Analyst / Cost Containment Specialist

Primary Location: Plymouth, MN
Additional Locations: AZ-Phoenix, CT-Hartford, FL-Tampa, IN-Evansville, MN-Plymouth, ND-Bismarck, NY-Amherst
Primary purpose of this position is to lead and manage the mission of obtaining the highest possible success rates and reductions on provider claims/bills, which result in savings to both the client and the insured.

Fundamental Components:
  • Reviews inpatient, outpatient and professional claims/bills with pre-established dollar thresholds to determine negotiation strategy and potential savings.
  • Capability to work in a production environment reviewing and negotiating 25-40 incoming claims/bills per day, on a daily basis.
  • Utilizes manager and experienced negotiators to develop dialogue, persuasive delivery, and approach to ensure successful negotiations.
  • Organizes and prioritizes incoming claims/bills to ensure client criteria are maintained (example: turnaround time) and established internal goals are met.
  • Works with all departments to obtain information such as plan benefits and insured liability, to assist in the negotiation process.
  • Handles phone and written inquiries from providers related to pre and post negotiations.
  • Investigates and resolves issues surrounding pre and post negotiated claims/bills.
  • Reviews provider and claim history to assist in determining appropriate percentage reduction for negotiation.
  • Contacts provider via phone and fax as set forth under the established guidelines for claims/bills negotiations.
  • Acquires a working knowledge of all lines of business including but not limited to Medical and Workers' Compensation.
  • Strives to develop and maintain provider relationships.
  • Documents system with information pertinent to claim/bill and provider.
  • Reviews claims/bills to initiate Long Term Agreements and Master Contracts.
  • Maintains and utilizes all resource material and systems to effectively manage job responsibilities.
  • Independently reviews and determines resolution for claim/bill issues and concerns.

Background Experience:
  • Experience in a production environment.
  • Medical Claims (examine, audit, process, etc) is REQUIRED
  • Claim Editing Skills is REQUIRED
  • Experience Benchmarking / able establish a reasonable rate & medical cost is REQUIRED
  • CPC Certification preferred
  • Licensure as required by state.
  • Must have “Medical Claims” experience, which could be claims examiner, auditor, coding of claims to submit to payers, doing system edits for a claim platform, and with “coding experience” preferred (2-5 years)
  • ​Should have both oral (telephone) and written aptitude which demonstrates accurate and effective communication and management of complex information (customer service, provider service, hospital billing, etc)
  • Exposure to, or experience with, contracting, negotiating, medical cost estimates (fee schedules), is desirable

Information Technology - Certified Professional Coder (CPC)

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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