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.
The Research Analyst is responsible for researching, analyzing and resolving projects or correspondence submitted by plans, providers and/or other stakeholders.
- Functions as Subject Matter Expert (SME) for Claims department.
- Analyzes complex operational claim payment problems and provides technical solutions.
- Identifies and recommends process improvement changes to existing processes and procedures which result in more efficient practices.
- Provides support to operations based on business needs.
- Responds to written providers’ inquiries.
- Maintains a current working knowledge of processing rules, contractual guidelines, plan policies and operational procedures to effectively provide technical expertise.
- Provides feedback regarding Online Help discrepancies and reports them to the Team Lead Educator.
- Provides technical and peer training as requested.
- Maintains accurate personal production records.
- Escalates claim and/or system issues to Team Lead or Supervisor.
- Completes provider correspondence and service forms as required.
- Creates and supports a professional environment which fosters teamwork, cooperation, respect and diversity.
- Meet department quality and production requirements
- This position is required to meet and maintain performance goals established for the position in the areas of quality and production.
- Process claims for multiple Line of Business as requested by management
- Understands processing rules for multiple lines of business and supports other lines of business as needed to meet business needs.
- 2 to 3 years claims processing experience.
- High School/GED required.
- Associate’s Degree preferred.
- In-depth knowledge of claims payment methodology.
- Excellent research and analytical skills.
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and leaning new computer programs.
- Ability to research and investigate information using multiple sources and documented guidelines.
- Ability to track and follow up on multiple projects.