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.

Responsibilities:

Under the direct supervision of the Claims Supervisor, reviews claims received via the external claims editing application to determine member eligibility in the Facets system to attach claims for processing for members. Follows all internal processes and procedures to ensure activities are handled per departmental and company policies and procedures.

• Research for member matches by comparing the External Claims Editing database with the Facets Health Care system.
• Create Service Forms for any discrepancies where the claim can not be routed to Facets, a member cannot be identified to match the member in Facets and should be directed to the Enrollment team for further investigation.
• Suspends claims to require additional information and special handling; initiates action to obtain needed information. Forwards claim to require external department intervention to the appropriate department or person. Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance.
• Responds to and resolves health plan claim inquiries. Monitors and tracks aged, pending, and open reports to maintain timeliness in claims processing. 

Education/Experience:

• High School/GED required.
• Associate’s Degree preferred.
• 1 to 3 years' enrollment or data entry experience preferred.
• Knowledge of medical terminology preferred
• Knowledge of medical billing/coding or related experience required
• Healthcare or Managed Care experience preferred.
• Minimum 35 wpm typing preferred.
• Working knowledge of PC applications in a Windows-based environment. 

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.