Job Category: Customer Service
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
The Aetna Strategic Business Unit Benefits Analyst will be expected to analyze client benefit requests, determine best operational approach and perform coding and testing for Commercial, Medicare and/or Medicaid business. The Benefits Team is also expected to validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. Responsibilities include, but are not limited to meeting or exceeding turnaround time and quality standards, as well as researching client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs. Applicants must be able to perform calculations or validations for claims.
The Aetna Strategic Business Unit Benefits Analysts are expected to demonstrate a high level of client service through the execution of accuracy, responsiveness, reliability, and professionalism on every interaction in a fast-paced Client Services Team. All team members must be positively demonstrate the ability to be flexible and adaptive to change. Other expectations include, but are not limited to the following:
• Assist to manage the resolution and status of routine to complex client requests with Account Management through effective and timely communication to ensure client expectations are met
• Work closely with internal departments to coordinate timely resolution of requests
• Responsible for identifying and documenting best practices within the Aetna Client Service Team
• Trending analysis, and supporting ad hoc situation and mentoring staff. Interface with internal and external clients via conference calls and written communication
• Cross training with Account Management Team Required Qualifications:
3+ years of relevant work experience. Knowledge, Skills, & Abilities Required: Thorough understanding of RxClaim platform/system applications/products Benefit design experience and understanding of system functionality and limitations Proficient in analyzing and executing clinical and non-clinical client work requests Well organized with the ability to effectively and independently prioritize work Excellent time management skills Excellent interpersonal and collaborative skills with the ability to work in a team environment Ownership and results driven Customer focused Attention to detail Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality Ability to creatively solve problems when dealing with a multitude of variables where standard resolution do not exist Ability to work effectively with multiple functional areas Flexible in adapting to change Demonstrated ability to analyze data and determine conclusions Ability to learn and apply increasingly complex concepts, policies and procedures Skilled in identifying and solving issues and recommending process improvements Ability to work successfully in a deadline-oriented environment Excellent verbal and written communication skills Project Management skills Ability to notice trends, perform root cause analysis, and champion solutions Excellent written and verbal communication skills Motivation to learn and grow within the organization Preferred Qualifications:
Work experience may includes PBM experience that demonstrates progressive upward growth. Knowledge of health care industry Government Claims experience Proficient use Microsoft Office applications, e.g. Excel, Word Education:
Bachelor's degree required or equivalent work experience. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day.
As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
Millions of times a day, close to home and across the country, we’re helping people on their path to better health.