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

Provider Data Services Analyst

Primary Location: San Diego, CA
Additional Locations: CA-San Diego
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Description:
Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.

Fundamental Components:
  • Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
  • Performs intake triage and responds to network inquiries, escalates when necessary.
  • Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
  • Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
  • Conducts audits of provider information and escalates issues for resolution as appropriate.


Background Experience:
  • Demonstrated PC skills, including Microsoft Office products and internet navigation skills.
  • Strong Excel skills a plus.
  • Previous industry experience or claims processing preferred.
  • High School Diploma or G.E.D.


Additional Job Information:
  • Understanding of medical terminology.
  • Strong knowledge of benefit plans, policies and procedures.
  • Oral and written communication skills.
  • Ability to maintain accuracy and production standards.
  • Technical skills.
  • Analytical skills.
  • Excel and Access experience.


Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information

Desired Skills:
General Business - Maximizing Work Practices, Service - Managing Organizational Dynamics, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology, Technology - Selecting and Applying Technology Solutions

Functional Skills:
Administration / Operation - Data Entry, General Management - Data analysis & interpretation, Network Management - Provider data services

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. 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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