Aetna Quality Audit Project Lead in St Louis, Missouri

Req ID: 56083BR

POSITION SUMMARY

Responsible for conducting highly complex quality management, procedural documentation, and/or special analysis audits and projects. Manages contractually required customer audits involving significant financial value and risk. Oversees multiple concurrent projects including planning, execution, evaluation and formulating corrective actions when necessary. Frequent and routine, client management and consulting firm consultation throughout the audit engagements for our fully insured business segments.

Fundamental Components:

Serves as subject matter expert in Quality Management, auditing practices, financial calculations, benefits, systems, external audits, internal audits, and internal controls for our Fully Insured business segments.

Serves as team leader to plan, organize, and facilitate multiple, concurrent projects of high complexity.

Reviews, in depth, the process documentation and previous audit indicators obtained during risk monitoring prior to the commencement of each assigned QA project.

Develops project plan based on agreed upon timeline with business area including overall delegation of work to team.

Performs preliminary project review and sign-offs, working with key stakeholders: manages the project scope and provides project feedback to project team.

Drafts the audit issues and reports for each assigned project that effectively communicates the purpose of the project and conclusions reached in a manner appropriate for senior leadership. Completes audit reports and Meritain audit issue responses for Senior Leadership review and sign off.

Manages project resource needs, identifies and communicates resource/administrative gaps, and works with department management to secure necessary resources to meet project objectives.

Manages time and expense budgets as well as project risks / barriers.

Participates in department wide activities such as training and staff development as well as management presentations to other Aetna or Meritain areas.

Provides oversight in the completion of process improvements, for each project.

Tests, documents, and confirms that interventions/solutions were effective in remediating and improving the quality of work for that which was in scope for the project.

Acts as a mentor to QA staff to provide support on the most complex audits.

Works with business unit leadership and their staff as necessary to review project findings, draft solutions, track corrective action plans, and track the installation of improvement solutions

BACKGROUND/EXPERIENCE desired:

Minimum of 7 years audit or related business experience, preferably within health insurance or related fields, demonstrating high proficiency in the competencies noted.

Must have significant project management experience within Quality or related field. BIG 4 Audit experience/leading engagements strongly preferred.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Business/International Institute of Business Analysis is desired

Audit/Certified Internal Auditor (CIA) is desired

Quality Assurance/ is desired

Project Management/Project Management Professional (PMP) is desired

FUNCTIONAL EXPERIENCES

Functional - Claims/Quality management/4-6 Years

Functional - Risk Management/Insurance, finance and loss control/1-3 Years

Functional - General Management/Process & quality improvement/1-3 Years

Functional - General Management/Data analysis & interpretation/1-3 Years

Functional - Management/Management - Operations/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/Power User

Technical - Modeling/Microsoft Visio/1-3 Years/Power User

Technical - Desktop Tools/Microsoft PowerPoint/4-6 Years/Power User

Technical - Desktop Tools/Microsoft Word/1-3 Years/Power User

Telework Specifications:

Tampa, Plymouth, or Lansing office locations.

ADDITIONAL JOB INFORMATION

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.