SIU Sr Analyst

Job Description
Under the direction of the SIU Triage Supervisor, the Sr. Analyst is responsible for collaboration with cross-functional teams of colleagues, primarily in the PDS Department as well as SIU Investigators, Supervisors, and Legal among others. This role requires detailed fact-finding research by utilizing various databases and tools to verify and validate certain new non-par high risk provider billing with potential for fraud, waste, or abuse. As a Sr. Analyst you will review all available documentation, gather additional relevant information (e.g., provider licensure, provider legitimacy, detailed analysis of provider billed services), and make actionable decisions. You may also work with assigned SIU Investigator, as necessary, to help investigate additional claim billing concerns identified.

Required Qualifications
• 3+ years claim processing and/or 2 years SIU analyst
experience.
• EPDB and Smart Front End mastery
• Strong analytical and research skills
• Proficient in researching information and identifying
information resources
• Strong verbal and written communication skills
• Ability to interact with different groups of people at
different levels and provide assistance on a timely
basis

Preferred Qualifications
• Team player who will contribute to the team success.
• Ability to utilize company systems to obtain relevant
electronic documentation
• Knowledge of Aetna's policies and procedures

Education
High School diploma, G.E.D. or equivalent experience
Bachelors degree preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.