Healthcare Claims Manager

Company:

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General Information
US-Nationwide
N/A
4 Year Degree
Full-Time
3 to 5 years
Not Specified
False
False
Job Description AmeriHealth Caritas currently has an opening for a Healthcare Claims Manager in Philadelphia, PA!

Healthcare Insurance Professionals, Apply Today

 

AmeriHealth Caritas is the nation's leader in health care solutions for the underserved and chronically ill, impacting the lives of nearly 5-million individuals nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we've become known for developing innovative solutions that help maximize health outcomes while reducing costs. Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP—plus pharmacy benefit management, behavioral health and administrative services.

 

Healthcare Claims Manager Responsibilities:

  • Manages the activities of the department.  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.
  • Performs other job related duties and projects as assigned.
  • Adheres to AMFC policies and procedures.
  • Supports and carries out the Company Mission & Values.

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    Healthcare Claims Manager Requirements:

  • 5+ years of Claims Management experience
  • Bachelor’s Degree, preferably in Business or Economics
  • Experience in the healthcare, managed care or insurance industry environment
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    Job Requirements

    Healthcare Claims Manager Requirements:

    • 5+ years of Claims Management experience
    • Bachelor’s Degree, preferably in Business or Economics
    • Experience in the healthcare, managed care or insurance industry environment
    Apply Now