Senior Analyst Claim Reporting and Special Services

Burjline Builders•Woonsocket, RI

11d•$46,988 - $112,200•Hybrid

About The Position

We are looking for a highly motivated candidate who can effectively and accurately oversee and coordinate rework projects, work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the project stays on track, is resolved accurately, interfaces with appropriate areas and is handled by the due date. The candidate will serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns. Projects may be national in scope, specific to a particular health network or state, and/or systemic in nature.

Requirements

Knowledge of Aetna claim and provider systems.
Regular project discussion/updates via conference calls.
Strong work ethic.
Efficiency and flexibility to meet critical turnaround objectives.
2+ years experience processing claims through the ACAS system.
Ability to work independently as well as part of the team; contributing to overall effectiveness of the team.
Ability to analyze data.
Able to successfully cope with the high demands of the job while effectively maintaining personal composure.
Initiative to improve personal performance as well as those of peers and team.

Nice To Haves

USQA reporting
Excel
Word
ACCESS

Responsibilities

Oversee and coordinate rework projects.
Work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims.
Ensure the project stays on track, is resolved accurately, interfaces with appropriate areas and is handled by the due date.
Serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns.