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This fast-paced, high visibility, executive-focused analytical role will evaluate changes to medical policy and their interactions with our network relationships to support the overarching Medical Economic mission statement of reducing medical costs and medical costs trends to provide more affordable healthcare to Aetna and CVS Health members while improving quality and access.
Job Responsibility:
Serve as a subject‑matter expert for transplant Institutes of Excellence (IOE) initiatives, provider reimbursement validation, and medical economics rental network reporting
Own recurring and ad‑hoc reporting used by leadership, audit, and cross‑functional stakeholders
Provides Local Market support to Medical Expense Review teams on medical policy and provider topics
Requirements:
Bachelor's degree along with 3 - 5 years experience and knowledge of: Complex data collection, modeling & analysis.
Experience working with Excel, MS-Access and Web-based query tools (SQL, BigQuery, etc.).
Finance background
Prioritizes & manages multiple projects while managing customer expectations and business priorities.
Work collaboratively and build relationships with customers.
Nice to have:
Knowledge of: Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
Understanding of internal and external database applications.
Knowledge of market-place delivery (understanding of provider relationships).
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching