Claims Team Lead – Remote Position Available In Allegheny, Pennsylvania

• 449471BR
• Auto req

ID:

• 449471BR

• Company:

• AmeriHealth Caritas

• Job Code:

• OperationsManager Operations Manager

• Job Description:

• On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest.

We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. 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 healthcare 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.

Work Arrangement:

This is a remote position.

Description:

Reporting to the LOB Supervisor the Team Lead’s primary responsibility is supporting the daily claims process. They are also responsible for providing support to the Supervisor.

Responsibilities:

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 identifying critical issues with projects and offers solutions Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity while developing and maintains working relationships with multiple functional areas in the Enterprise. Provides technical and peer in-service training, including side-by-side training Prepares daily inventory reports and assisting in Managing Inventory. Assists Supervisor in assigning work to staff and attends meetings as directed by supervisor or manager Participates in OLH Processing Rule Committee. Supports Claims Team Management (Director, Manager, Supervisor) with reports, unique processes, projects and Is a knowledgeable Subject Matter Expert of each LOB-supported Assists in addressing audit reports and quality review feedback

Education & Experience:

Associate’s or Bachelor’s Degree Minimum of 4 years of experience in healthcare claims processing, required Claims Medicaid and/or Exchange knowledge, required Excellent Written and Verbal Communication Skills along with strong analytical skills Proven leadership experience 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.

• Position Title:

• Claims Team Lead – Remote

• Job Category:

• Operations

• Minimum Education Required:

• Associates
• City
• :•Pittsburgh •State•:•Pennsylvania