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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Quality Consultant

Primary Location: Rockville, Maryland
Additional Locations: MD-Rockville

Job Description:

Accountable for review and/or handling of quality complex audits. Uses analytical and statistical techniques and tools to evaluate and model business processes. Influences enhancements to business processes and system infrastructure to improve quality data.

Fundamental Components:

Fundamental Components:

Subject matter expert on workflows, policies, components of systems and on daily operations and programs Use analytical and statistical techniques and tools to plan and perform research and analysis of processes (e.g., outcomes performance guarantees, government regulations, and customer requirements, etc.) to recommend enhancements and workable solutions by cost benefit analysis Responsible to support targeted quality audit projects. Report results and make recommendations e.g., training needs, quality controls and procedures) In partnership with business owners, support the design and development of new processes Develop and implement quality programs and initiatives. Participate in the development and validation of master or detail test plans and strategies May develop and design data collection capability (e.g., customer surveys focus groups, system reports) Under direct supervision, develop and deliver training May provide guidance or expertise to quality staff Facilitate team sessions to develop processes and/or resolve issues May support sales and marketing in their efforts to acquire and retain customers [e.g., responding to RFP's (Request for Proposal), quality presentations, and request for measurement information] Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous quality improvement initiatives Analyze and resolve complex claims scenarios within established time frames Identify and recommend internal and external benchmarks and appropriate measures for performance evaluation May, under supervision, develop quality assessment/audit/measurement programs tailored to specific assignments Analyze customer feedback and other measures

Background Experience:

Experience Desired:

3 - 5+ years work experience in the audit environment that reflects a proven track record or proficiency in the competencies noted.
High school diploma or equivalent.

Additional Job Information:
This job will provide you
with a great opportunity to grow, learn, and expand your knowledge of the work
that is done in the Fed Plans area.

Required Skills:
General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Creating Accountability

Desired Skills:
General Business - Applying Reasoned Judgment, Technology - Leveraging Technology

Functional Skills:
Claim - Claim processing - Medical or Hospital - ACAS, Claim - Claim processing - Pharmacy, Claim - Overpayment recovery, Claim - Quality management

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. 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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