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AmeriHealth Caritas Manager Claims in Philadelphia, Pennsylvania

Manager Claims

Location: Philadelphia, PA

Telecommuter?: No

ID**: 18262

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re 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’d like to hear from you.

Headquartered in Philadelphia, 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 .

Responsibilities:

The Manager of Claims is responsible for the coordination of all operational activities related to the Claims Unit (claims processing, provider claims services, research and projects) for both Medicare and Medicaid products. Responsible for operational and compliance performance, including adherence to state and federal laws and regulations; ensure compliance to CMS claim operations requirements, and performance related to CMS audits and ratings; resolution of complaints. Ensures that priorities/tasks are completed on time. Identifies and resolves operational issues using well-defined/documented processes, expertise and judgment. Ensures that performance standards are met in accordance with the (SLA). Coaches team to meet and/or exceed performance goals. Measures performance and makes promotional and disciplinary decisions. Assists in the development of a consolidated operating budget. Makes efforts to control costs while seeking ways to increase productivity, improve quality and enhance revenue. Hiring responsibility for operations associates. Provides career/professional development to new and existing team members. Keeps abreast of new developments in area(s) of responsibility and ensures timely communication to team. Responsible for internal and customer initiated audits, regulatory reviews and customer certifications (HEDIS and NCQA). Manages operational programs to provide information necessary to improve production. Works with Work Force Management to ensure staffing allocations are managed and assigned based upon production and SLAs.

Education/Experience:

  • 1 to 3 years of supervisory experience.

  • 5 plus years' experience of management experience.

  • 3 plus years' experience in healthcare, managed care or insurance industry environment required.

  • Bachelor’s Degree equivalent work experience required.

  • Previous claims management experience required.

EOE Minorities/Females/Protected Veterans/Disabled

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