Job Position: Network Operations Consultant
Job Description: Aetna – Dubai – Network Operations Consultant Job Group Health Care Req# 50657BR Primary Location ARE-Dubai Locations ARE-Dubai Full or Part Time Full Time Supervisory No Job Description Family Summary Providing strong support to the global direct settlement network andachieve our common purpose of “healthy; anytime, anywhere” by ensuring that ourcustomers receive appropriate treatment at the time and location of theirchoosing. Support the development and deployment of operational and technologysolutions to deliver fast and effective claims flows and reconciliations; andmaximize cost-effectiveness with TPAs and providers. Position Summary Supports the development, and managementof strategic Network Operations activity in alignment with broader businessobjectives. Strong organisational skills toeffectively manage their own work. Supports the effective operation of abroad spectrum of regional direct settlement healthcare facilities for allcustomer types. Supports the creation of effectiveprocesses that provide visibility of claims activities across our provider andTPA network Supports the creation and execution ofrobust control points throughout the claims journey to enable timelyreconciliations. Assist in executing TPA andProvider claim audits to manage claim costs and identify and report fraud,waste and abuse. Works closely with TPA and Aetna Claimsteams to deliver claims reconciliations as required. Develops and maintains strongcollaborative relationships within Aetna and TPA Operational teams, as well aswith the Sales/Account Management teams and our business partners throughoutthe region. Working closely with the HGS VendorManager to ensure that Aetna receive, process and pay TPA claims in an accurateand timely manner. Reviewing the claims process toensure that the highest quality standards are applied to the entire claimsjourney, from receipt of the TPA/provider claim through to payment and EOB.Working with the claims teams to deliver change as required. D…see more details
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