Aetna Quality Analyst in Amherst, New York

Req ID: 55010BR


Primary responsibility of this position is to review all types of medical and dental claims for accuracy using the groups plan documents, Meritain Health procedures and industry standards. Our objective is reporting for company, group and individual accuracy statistics, training feedback and trending of issues both for system and examiner adjudication.

Fundamental Components:

Audit medical and/or dental claims. (30%) Analyze and interpret plan documents (30%) Troubleshoot and propose solutions to decrease audit errors (20%) Provide investigative support to management (5%) Document new procedures as needed (5%) Request claim adjustments when needed (5%) Cross train on other responsibilities within the department(5%)


1 -3 years of claim processing and/or audit experience.

Knowledge of health claim processing (example COB, Medical Necessity, Pre Existing, U&C

Keyboard and computer familiarity

Knowledge of Preferred Provider Organizations


The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.


Functional - Claims/Claim processing - Dental/1-3 Years

Functional - Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years

Functional - Claims/Quality management/1-3 Years


Technical - Computer Operations/System and Console Operations/1-3 Years/End User

Technical - Aetna Applications//1-3 Years/End User


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.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Quality Management

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.