Position Summary

The Medicaid Intake Operations Team plays a critical role ensuring the accuracy and integrity of all Electronic Data Interchange (EDI) and claims intake processes within the Medicaid line of business. We are seeking a Manager Claim Technical Analyst (Medicaid Intake Operations) with a strong foundation in SQL, EDI transactions, and claims operations.

In this role, you will:

• Serve as the Technical Subject Matter Expert (SME) for intake rules and matching logic.
• Liaise with providers and internal teams to resolve questions about EDI and Claims Intake rejections.
• Provide second-level expert support for intake claim rejections.
• Analyze large datasets for research and troubleshooting.
• Collaborate with Product Owners and IT teams on system enhancements and fixes.
• Participate in testing and verification of business rules and validations.
• Manage multiple projects and tasks simultaneously while maintaining high-quality results.
• Support Product Owners, Business Owners, and Leads using technical and analytical expertise.
• Communicate effectively across all levels of the organization, including cross-functional teams.
• Write complex SQL queries to join multiple data sources and analyze data for root causes, trends, and opportunities.
• Lead the creation of automated reporting solutions using Tableau, Excel, and other tools to deliver actionable insights.
• Translate complex data analysis into clear, actionable information for non-technical audiences.
• Analyze EDI and Claims intake rejections from internal and external inquiries, including provider calls.
• Track and execute solutions for identified issues.
• Perform User Acceptance Testing for logic changes and enhancements.
• Develop utilities, queries, and processes for post-production checkout of business rules and system fixes.

Required Qualifications

• 3–5 years of experience as a SQL Server power user (coding and developing data extracts).
• 5+ years of data interpretation and analysis experience.
• 4+ years working with data visualization tools (Tableau, Power BI, or equivalent); expertise in data storytelling and preparing data for presentation in Excel and PowerPoint.
• 5+ years querying large datasets using SQL, SAS, or other data tools.
• Strong documentation skills; writes readable and reproducible code.
• Proficient in Word, PowerPoint, Excel.
• Self-starter with the ability to work independently and prioritize multiple deliverables.
• Demonstrated ability to manage conflicting priorities and concurrent projects.
• Excellent verbal and written communication skills, able to communicate technical ideas to non-technical audiences.
• Strong problem-solving, analytical, and critical thinking skills.

Preferred Qualifications

• Advanced Excel skills (pivots, formulas, V-lookup).
• 2+ years working with EDI transactions (including but not limited to 837s, 277s, 999s, 275s, 835s).

Education

• Bachelor’s degree or equivalent work experience.

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. 

Aetna Service Operations office/hub locations will be discussed with the selected candidate.