Analyst, Quality Audit Control II
$43,888–$102,086 year
Remote · Arizona, United States or New York, United States
Job Summary
Analyst responsible for Enterprise Quality Assurance and fiduciary controls for Aetna, performing quality audits for service operations across multiple products/platforms and serving as the official source for performance reporting, SOX/SOC1 controls, and SLA/book-of-business metrics. Must have strong analytical, organizational, and communication skills with experience in Medicare/Medicaid High Dollar claim processing or auditing. Hybrid-work expectation with potential onsite/hub locations; full-time, 40 hours weekly, and a comprehensive benefits package. Familiarity with Medicare/Medicaid policies and quality improvement opportunities is preferred.
Required Qualifications
- 1 plus year(s) Medicare or Medicaid High Dollar Claim Processing and/ or Medicare or Medicaid High Dollar Claim Auditing Experience
- Preferred Qualifications Knowledge of Medicare and Medicaid e.polices.
- High proficiency in processing Medicare or Medicaid High Dollar claims.
- Associate’s degree of above preferred.
- Education High School Diploma or equivalent G.E.D.
- We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy.
- Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
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