Aetna Operational Accounting Consultant in Houston, Texas

Req ID: 36159BR

This position has potential for telework for existing Aetna teleworkers. In addition, you could work out of any of our service operations strategic sights: Albany NY, Allentown PA, Harrisburg PA, Cranberry PA, Arlington TX, Bismarck ND, High Point NC, Houston TX, Jacksonville FL, New Albany OH, Newark DE, Phoenix AZ, or Sandy, UT.


The mission of the Service Operations, Operational Accounting (OA) and Cost Containment Root-Cause teams is to find and fix issues that will help us to pay claims accurately. In the Operational Accounting Consultant position, you will be responsible for analyzing claim overpayment issues, collaborating with business partners to determine claim overpayment root cause, and implementing claim overpayment root cause resolutions in order to reduce medical cost.

Fundamental Components of the OA Consultant position include, but are not limited to:

Identifies new claims overpayment root cause concepts Manages ongoing projects Provides claims overpayment root cause analysis Analyzes and interpreting OPT data (OPT is a database system used to track/report overpayments) Manages and provides reporting for constituent files by collaborating with business partners for resolution of claim overpayment issues Reviews and analyzes contract management reimbursement terms and policy/payment rules; identifies improper payments made to physicians, hospitals and other medical providers. Investigates medical claim data in conjunction with insurance payer contracts to identify payment errors. Extensive utilization of data mining technologies to identify payment issues. Provides subject matter expert (SME) consultation and advice in some functional areas of responsibility, providing recommendations on workflows, policies, components of systems and in daily operations and products. Shares business knowledge and participates in the training and guidance of less-experienced staff members; exercises latitude to deviate from standard policies and procedures within established limits . Fosters and supports collaboration across organizations and builds strong and effective work relationships; works with internal and external constituents and business owners by providing subject matter expertise to resolve reconciliation discrepancies, implements process improvements and enhanced workflows. Provides accurate, timely and insightful analysis in response to ad hoc requests and issues. Utilizes technical skills to streamline and improve existing processes. Trouble-shoots problems and provides solutions based on practices, existing precedents or procedures.


3+ years experience claims processing experience with proficiency on ACAS or HMO system, or like capability Strong analytical/investigative skills Strong Excel and/or WEBI knowledge Ability to organize/manipulate large data sets Excellent verbal and written communication Flexible and able to adapt to changing priorities Self-starter and able to work independently.


The minimum level of education desired for candidates in this position is a High School Diploma or equivalent experience.


Functional- Claims, Claims processing Medical or Hospital ACAS 1-3 years, and Functional- Claims, Claims processing Medical or Hospital HMO 1-3 years.


Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User


General Business/Applying Reasoned Judgment/ADVANCED

General Business/Maximizing Work Practices/ADVANCED

Technology/Leveraging Technology/FOUNDATION


General Business/Communicating for Impact/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Service/Providing Solutions to Constituent Needs/ADVANCED


Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Customer Service