Claims Team Lead
Claims Team Lead
Posted on :
23-06-2025
Employer Active
1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
23-06-2025
Job Description
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 nations 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 .
Work Arrangement:
This is a remote position.
Description:
Reporting to the LOB Supervisor the Team Leads 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:
Associates or Bachelors 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.
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 nations 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 .
Work Arrangement:
This is a remote position.
Description:
Reporting to the LOB Supervisor the Team Leads 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:
Associates or Bachelors 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.
Employment Type
Full Time
Key Skills
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