Health Services Plan Team Lead | AmeriHealth Caritas | Remote (US)

Health Services Plan Team Lead | AmeriHealth Caritas | Remote (US)

Remote US
Application ends: July 23, 2024
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Job Description

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Description:

The Team Lead’s primary responsibility is supporting the daily claims process.  Secondarily, they are responsible for providing support to the Knowledge Management Team Lead as required.

Responsibilities:

  • Reports to LOB Supervisor.
  • Functions as a technical specialist for claims operations.
  • Maintains a current working knowledge of LOB processing rules, contractual guidelines, plan policies, and operational procedures.
  • Resolves and provides directions to Front End Claims Examiners and Research Analysts regarding complex claims.
  • Assists in managing inventory.
  • Assists in identifying critical issues with projects and offers solutions.
  • Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
  • Provides technical and peer in-service training, including side-by-side training.
  • Prepares daily inventory reports.
  • Assists Supervisor in assigning work to staff and attends meetings as directed by supervisor or manager.
  • Develops and maintains working relationships with multiple functional areas in the Enterprise.
  • Participates in OLH Processing Rule Committee
  • Is a knowledgeable Subject Matter Expert of each LOB-supported.
  • Supports Claims Team Management (Director, Manager, Supervisor) with reports, unique processes, projects.
  • Assists in addressing audit reports and quality review feedback.
  • Provides backup support for the Knowledge Management Team Lead. 

Education & Experience:

  • Associate’s or Bachelor’s Degree
  • Minimum of 4 years of experience in claims processing health and dental claims.
  • Knowledge of Facets, EXP, Jiva is a plus.  Able to run reports on MS Access Database.
  • Knowledge of Medicare Claims.
  • Excellent Written and Verbal Communication Skills.
  • Some Leadership experience required.
  • Strong analytical skills

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.