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Aetna Inc
- Hartford, CT / Scottsdale, AZ / Jacksonville, FL / 4 more...
Position is office based in Hartford CT preferably. Open to other locations and possibly telework for strongly qualified candidates Aetna's Law and Regulatory Affairs Department is a thought leader managing the legal, compliance, product and regulatory approvals for Aetna. Our mission is to assist in the transformation and success of our business while promoting an ethical, compliance culture and
Posted Today
Aetna Inc
- Tampa, FL / Lansing, MI / Plymouth, MN / 1 more...
The position will report to the Adjustments & Recovery Team and will be responsible for completing adjustments to previously processed claims and assisting with recovery of over payments. Fundamental Components Processing adjustments to previously processed claims. Track adjustment errors for process improvement. Work with other areas of operations on improving claims processing. Actively particip
Posted Today
Aetna Inc
- Plymouth, MN / Amherst, NY
Performs a broad range of basic, entry level tasks and assignments of operational/financial activities in support of revenue or claim information. Fundamental Components Performs, under direct supervision, general data gathering and analysis in support of assigned operational accounting discipline. Analyzes and validates system results to ensure accuracy, accountability and financial data integrit
Posted Today
Aetna Inc
- Hartford, CT / Washington, DC / Wellesley, MA / 2 more...
The Key Accounts Solutions Director sets and executes the product and solution strategy for Aetna in the key account employer group market, which includes employers that range from 301 2999 employees and works in collaboration with the Large Group Solutions leader. Fundamental Components As the owner of solution strategy in this critical segment, the Key Accounts Solutions Manager must partner tig
Posted Today
Aetna Inc
- Hartford, CT / Washington, DC / Jacksonville, FL / 13 more...
The Senior Medical Director provides leadership for the design and execution of medical management activities that lead to successful ACO relationships as defined by the Triple Aim. The SMD will develop and implement medical management programs/policies. You will leads, develop, direct and implement clinical and non clinical activities that impact health care quality, cost and outcomes. You will s
Posted Today
As a Care Management Associate, you will support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Fundamental Components Care Management Team Intake Responsible for initial review and triage of C
Posted 2 days ago
Leads new/innovative product ideation or development of enhancements for prioritization and delivery to support the companys business strategy and value proposition of products that are consumer centric and tied together. Accountable for the end to end development and management of business strategy including market and financial/profitability analysis for the overall portfolio offering. Fundament
Posted 2 days ago
Role will support the Business Outcomes organization sales, account management and business retention for Aetna products and services in support of profitable growth and other business objectives. Essential to this role will be meeting annual sales targets, successfully managing accounts and managing projects in cooperation with internal stakeholders. Fundamental Components Generate a specific amo
Posted 2 days ago
This position is with American Health Holding, an Aetna company. The UM Nurse utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 11 30AM 8PM ET. This is a full time telework (WAH) position with a required two week training in New Albany, OH upon hire. Fundamental Components Utilizes clinical e
Posted 2 days ago
Aetna Inc
- Hartford, CT / Wellesley, MA / New York, NY
Aetna Analytics & Behavior Change (ABC) mandate is to transform health and wellness through data analytics & machine learning products that enable consumer engagement and a best in class experience. This team is responsible for building data products, involving real time ingestion frameworks, data pipelines to process large volumes of poly structure data, and model deployment; as well as the envis
Posted 2 days ago
Aetna Inc
- Phoenix, AZ / Jacksonville, FL / High Point, NC / 5 more...
Office based position only but can be located at any Aetna office location. The Medicare Compliance Lead must ensure that the requirements of an effective Medicare Compliance program are met as expressed by the Centers for Medicare and Medicaid Services (CMS) in Chapters 9&21. Fundamental Components The Compliance Lead must have specialized expertise in compliance, business, analytical and communi
Posted 2 days ago
Aetna Inc
- Tampa, FL / Plymouth, MN / Amherst, NY
Reviews and adjudicates complex, sensitive and/or specialized claims in accordance with claim processing guidelines. Responsible for complex issues, handles customer service inquiries and problems. Fundamental Components Reviews pre specified claims or claims that exceed specialist adjudication authority or processing expertise. ( ) Applies medical necessity guidelines, determine coverage, complet
Posted 2 days ago
Aetna Inc
- Scottsdale, AZ / Fresno, CA / Jacksonville, FL / 11 more...
This position will join our Digital Operations team supporting DocFind with primary responsibility to partner with technical teams, network, PDS, and EPDB to research and resolve provider display questions. This individual will also work closely with sales and technical teams to create and maintain custom versions of the website. Fundamental Components 1) Support DocFind day to day operations (res
Posted 2 days ago
Aetna Inc
- San Francisco, CA / Tampa, FL / Chicago, IL / 7 more...
Supports complementary marketing strategies to external partners with Aetna branded and brand agnostic Medicare marketing to ensure growth of core, high growth and disruptive marketing opportunities. Provides leadership that helps evaluate external proposals for efficacy and ROI, then collaborating with external partner and sales director to drive high volume, high efficiency and leading edge stra
Posted 4 days ago
Aetna Inc
- Hartford, CT / Albany, NY
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program within the DCAT Team. Requires an RN with unrestricted active license and may require some weekend hours or rotation of hours to accommodate business needs. Fundamental Components Reviewing services to assure medical necessity Applying clinical expertise to assure appropriate
Posted 4 days ago
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