Name of The Company: Aetna
Name of the Post: Senior Analyst
Qualification Need: Graduation
Location: Honolulu, USA
What’s the Salary: $20-$30/Hour
Job Description
This Position Is Responsible For Overseeing Our Third Party Claims Administrator (TPA) To Ensure The Investigation, Handling And Resolution Of Our Claims To Achieve The Best Financial Claim Outcome. Ability To Analyze And Lead Our Tpas To Ensure Adequate Budget Reserves Should They Reflect Appropriate Exposures. A Tool To Hold Tpas Accountable For Implementing Our Claims Service Instructions (CSI). Ability To Audit Files To Identify Non-Compliance With CSI And Perform Processes And Monitoring To Ensure Compliance. Ability To Understand And Analyze Kpis To Ensure Trends Reflect Our Goals And Ability To Interpret Various Types Of Reports. Emphasis On Identifying Potential Key High Exposure Cases And Strategic Ability To Drive Cases To Resolution While Regularly Reporting To Our Sr. Lieder Ability To Serve As A Mentor To Less Experienced Venture Partners. Extensive Interaction With Internal Departments, Management And Our Third Party Claims Manager Is Required To Ensure Timely And Accurate Review And Resolution Of Claims.
Main Responsibilities:
- Directly Responsible For The Management And Investigation And Settlement Of Our Third Party Claims Manager To Achieve A Best In Class Claims Operation.
- Ability To Proactively Manage And Manage TPA Through Reporting, Auditing, Claims Review.
- Active Participant In TPA Operational Meetings, Supervisory Boards, Complaints Reviews And Round Tables.
- Analyze Case And Internal Research Materials To Determine Legal Liability And Risk To Ensure Appropriate Placement Of Reserves.
- Review And Interpret Medical Reports, Expert Reports And Various Supporting Documents Related To Claims.
- Excellent Analytical, Organizational, Written And Communication Skills. Ability To Create A Requirements Brief That Captures And Details The Critical Elements Of The Case.
Note That This Range Represents The Salary Of All Positions In The Job Class In Which This Position Falls. The Actual Salary Offer Will Take Into Account Many Factors, Including Location.
Required Qualifications
- 8+ Years Of Experience Handling Workers Compensation Claims For A Healthcare Company, Insurance Carrier, Third Party Claims Adjuster Or Self-Managed Company.
- More Than 5 Years Of Management Experience For TPA / Carriers
Preferred Qualifications
- Demonstrated Time Management Skills And Proven Ability To Handle Multiple Cases.
- Ability To Train Less Experienced TPA Adjusters To Implement Procurement Best Practices.
- Ability To Work Independently And In An Environment That Requires Teamwork And Collaboration.
- Ability To Navigate Difficult Situations With Internal And External Teams.
- Have Excellent Customer Service Skills And Attitude; Demonstrated Ability To De-Escalate Requesters Leading To Productive Dialogue And Resolution.
- Demonstrated Ability To Represent The Company Positively And Aggressively In Mediations Or Arbitrations.
- Experience With Microsoft Applications With Demonstrated Ability To Learn New Software Programs And Systems As Needed.
- Experience Handling CA Workers Compensation Claims Or Knowledge Of CA Jurisdiction Is A Plus.
