Senior Field Case Manager RN – Medicaid Expert

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

Benefits offered by this job

401(k) plan

Employee stock purchase plan

Paid time off

Job summary

Aetna is seeking a Senior Case Advantage Subject Matter Expert (Operations) to assess, investigate and settle complex, sensitive, state-driven cases, potentially learning multiple Medicaid plans. Prior claims handling is a fundamental prerequisite, with emphasis on accuracy and efficiency.

The role requires strong analytical skills, ability to manage multiple tasks, and proficiency with MS Office. This full-time position offers comprehensive benefits and opportunities for professional growth.

Qualifications

• 2 years Clinical Cases handling experience (Business, Medicaid, Government care).
• Experience in a production environment.
• Analytical abilities, with the capacity to explore complex issues such as denied claims.
• Proven ability to multitask accurately and efficiently.
• Proven proficiency with PC, routing through console, and MS Office Suite.

Responsibilities

• The Senior Case Advantage SME surveys, investigates and resolves complex, sensitive experiences per state-driven experience handling rules.
• May be required to learn multiple Medicaid plans.
• Handle claims and navigate across cases with attention to detail.

Skills

Clinical cases handling

Medicaid knowledge

Analytical thinking

Education

Bachelor Degree

Tools

QNXT

Edifecs

MS Office

Job description

Aetna is seeking a Senior Case Advantage Subject Matter Expert (Operations) to assess, investigate and settle complex, sensitive, state-driven cases, potentially learning multiple Medicaid plans. Prior claims handling is a fundamental prerequisite, with emphasis on accuracy and efficiency.

The role requires strong analytical skills, ability to manage multiple tasks, and proficiency with MS Office. This full-time position offers comprehensive benefits and opportunities for professional growth.