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Senior Analyst

Primary Location: San Francisco, California
Additional Locations: AZ-Phoenix, CA-San Diego, CA-San Francisco, CA-Walnut Creek, PA-Allentown, PA-Blue Bell, PA-Harrisburg, PA-Philadelphia, PA-Pittsburgh
The MSO Claim Policy Consultant will provide guidance and support to all Medicare functional areas ensuring compliance with CMS expectations for Medicare Advantage Organization's Part C medical claims processing.

Fundamental Components:
The Medicare Benefit Plan and Claim Administration Team is seeking a strong team
player to work closely with the Claim/Call Policy team to ensure all policies
and procedures are documented accurately and timely in support of our Medicare
book of business. The Policy Consultant will assist with the transition efforts
of existing customers converting to any of our Medicare products from our
commercial businesses as needed which may include plan set-up and enrollment
activities; work closely with the Medicare Compliance department to ensure all
processes, policies, procedures and training adheres to CMS standards; provide
consultative support and subject matter expertise on various projects,
workgroups, new Medicare product initiatives, end-user applications, and vendor
relationships; review/analyze changes by CMS to ensure adherence in existing
procedures and implement changes as needed; and review/analyze claim data to
assist in determining root cause problems and propose solutions/corrections. As
the position develops, additional responsibilities will be added as deemed
necessary by the business. Prior claim or call experience on the HMO claim
platform is required to be considered a candidate for these positions.

Background Experience:
Strong knowledge of Medicare Claims processing and superior organizational skills. Flexibility and reprioritization skills are a must. Knowledge of all types of Medicare Advantage managed care products including HMO, PPO, and Open Access. 0-3 years of data interpretation and analysis experience and working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook)

Functional Experience:

Functional -
Claims - Claim processing - Medical - Medicare/4-6 Years

Functional -
Claims - Policies & procedures/1-3 Years

Technology Experience:

Technical -
Desktop Tools - Microsoft Word/1-3 Years/End User

Technical -
Desktop Tools - TE Microsoft Excel/1-3 Years/End User

Required Skills:

Business and Industry Acumen

Work Practices

Turning Data
into Information

Desired Skills:

Business and Industry Acumen

Work Practices

Turning Data
into Information

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

Click To Review Our Benefits (PDF)


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