Senior Consultant - Provider Data Services - Configuration/Research
Company: Aetna Inc.
Posted on: June 4, 2021
Provides consultation on the design, testing and enhancement of
claim and contract configuration setup including technical support
to external providers and internal customers. 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 data configuration efforts.
Develops a consultative relationship with external providers and
- May lead or act as a business technical expert with the
planning, development and validation of master or detail test
- Performs ongoing research, and support tasks for existing
claims and contract configuration.
Acts as a business technical consultant in the design of new
applications or enhancements including integration of
- Provides Leadership/Coaching/Mentoring; may be a mentor to
- Directs the implementation of program specific information
through provider education, technology, organizational methods and
- Influences enhancements to business processes and system
infrastructure to improve data quality availability and
- Manages customer contact and participates in internal and
external health industry development efforts (e.g., claims
- Analyzes complex data for trends, highlights in-depth
interpretations and provides in-depth root cause analysis.
- Consults with provider on a regular basis to ensure progress is
in line with provider's expectations and to obtain additional
information as needed.
- Translates complex claim data into constructive data and
information and makes recommendations.
- Defines, identifies, develops and implements information
products to support strategic business and operational
- Illustrates complex information in a clear concise manner.
- Develops and conducts presentations and consultations to
existing and prospective providers and internal business
- Provides workgroup support on projects Influences
changes/enhancements to business processes, policies, and system
infrastructure to improve information quality, availability and
- Promotes and educate providers on cultural competency
- Interprets contractual requirements including federal and state
regulations and NCQA.
- Independent resolution of claim problems. Assist others with
resolution of problems involving research into both provider and
regulator policy data.
- Assist with analyzing and the resolution of error situations
that require system research; such as claim audit results.
- Reviews all management level claim reports for validity,
accuracy and trends.
- Ensures internal as well as external financial transactions
associated with unit functions are appropriately applied.
- Monitors and reviews designated claims system activity and
proactively leads investigation of discrepancies and trend
- Conducts peer to peer training on claim systems and service
functions for new and existing staff. Makes presentations to peers
and customers (internal and external).
- Excellent verbal and written communication skills.
- Extensive experience with databases as well interpretation and
manipulation of related data.
- Healthcare background.
- 3-5 years of data interpretation and analysis experience.
- Bachelor's degree, technical certification or equivalent work
Please review required qualifications above
Bachelor's degree or equivalent experience
At Aetna, a CVS Health company, we are joined in a common
purpose: helping people on their path to better health. We are
working to transform health care through innovations that make
quality care more accessible, easier to use, less expensive and
patient-focused. Working together and organizing around the
individual, we are pioneering a new approach to total health that
puts people at the heart.
We are committed to maintaining a diverse and inclusive
workplace. CVS Health is an equal opportunity and affirmative
action employer. We do not discriminate in recruiting, hiring or
promotion based on race, ethnicity, gender, gender identity, age,
disability or protected veteran status. We proudly support and
encourage people with military experience (active, veterans,
reservists and National Guard) as well as military spouses to apply
for CVS Health job opportunities.
Keywords: Aetna Inc., Kenner , Senior Consultant - Provider Data Services - Configuration/Research, Other , Kenner, Louisiana
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