Remote Sr Analyst, Network Relations - $30+/hr

MaziCTools; Los Angeles (CA); Hybrid; USD 41,000 - 56,000; Full time

Job summary

Aetna in California seeks a Sr Analyst, Network Relations to audit supplier and provider claims and ensure CCR review compliance. The role requires a Bachelor Degree and strong client support skills. You will work with internal and external teams, maintaining privacy and following established processes.

The position is full-time in California, with 8-hour workdays. Salary range is $30–$41 per hour, with the organization offering comprehensive benefits.

Qualifications

• Experience in claims processing and multitasking.
• Understanding of clinical terminology or phrases.

Responsibilities

• Audit supplier and party claims to determine CCR review eligibility.
• Follow processes, templates, and legal/compliance needs to provide a complete picture for CCR clinicians and medical directors.
• Prioritize tasks to meet regulatory and CCR guarantee completion times.
• Determine inclusion, verify qualifications, benefits, identify errors, and apply Clinical Case Management approaches.
• Collaborate with internal and external teams to review claims and resolve issues found during audits.
• Maintain and use all resources and systems to manage job responsibilities.
• Adhere to company policies to protect member privacy.

Skills

Client support experience

Clinical Terminology

Education

Bachelor Degree

Job description

Aetna in California seeks a Sr Analyst, Network Relations to audit supplier and provider claims and ensure CCR review compliance. The role requires a Bachelor Degree and strong client support skills. You will work with internal and external teams, maintaining privacy and following established processes.

The position is full-time in California, with 8-hour workdays. Salary range is $30–$41 per hour, with the organization offering comprehensive benefits.