Analyst, Quality Audit Control II
About The Position
The Enterprise Quality assurance program and fiduciary control for Aetna. Performs quality audits for service operations for multiple products and platforms and is the official source for Customer/Plan Sponsor performance guarantee reporting, SOX and SOC1, Internal Audit/Compliance controls and the official source for Service Level Agreements ( SLA for Vendor) and Book of Business reporting. Government Programs Claim Quality is an exciting and fast paced high performance organization. We are Aetna's Enterprise Level Quality Assurance Program focusing on quality improvement, trending and training opportunities. Government Programs Claim Quality is the official source for all customer performance guarantee and key performance metric reporting. We are the SOX and Sarbanes control for Medicare and Medicaid Claim Processing. We are looking for a flexible customer focused individual who enjoys working in a team environment and can create value by anticipating and exceeding customer expectations. The ideal candidate will have exceptional analytical, organizational and problem solving skills effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive attitude. Successful candidates should be fully trained in Medicare or Medicaid High Dollar claim processing and comfortable with quality and production goals.
Requirements
- 1 plus year(s) Medicare or Medicaid High Dollar Claim Processing and/or Medicare or Medicaid High Dollar Claim Auditing Experience
- Fully trained in Medicare or Medicaid High Dollar claim processing
- Comfortable with quality and production goals
Nice To Haves
- Knowledge of Medicare and Medicaid e.polices
- High proficiency in processing Medicare or Medicaid High Dollar claims
- Associate’s degree of above preferred
Responsibilities
- Performs quality audits for service operations for multiple products and platforms
- Official source for Customer/Plan Sponsor performance guarantee reporting, SOX and SOC1, Internal Audit/Compliance controls
- Official source for Service Level Agreements (SLA for Vendor) and Book of Business reporting
- Focusing on quality improvement, trending and training opportunities
- Official source for all customer performance guarantee and key performance metric reporting
- SOX and Sarbanes control for Medicare and Medicaid Claim Processing
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
