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 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.

Job Summary

Under the direction of the Manager, Enterprise Operations Reporting and Controls, this position is responsible for the coordination, preparation, delivery, and maintenance of the Contact Center and Member Grievances reporting suite governed by the EO Reporting & Controls team. This suite includes but is not limited to: health plan statutory reporting, National Committee for Quality Assurance (NCQA) and Quality of Service Committee (QSC) reporting, and ad-hoc requests for Contact Center and/or Member Grievance data. The day-to-day responsibilities of this position are to: 

Essential Functions

• Support the coordination, preparation, delivery, and maintenance, of various Contact Center and Member Grievance reports to allow for data-driven decision making.
• Identify, research and analyze data outliers and/or irregularities in departmental and interdepartmental reports.
• Collaborate with internal and external stakeholders to maintain a current working knowledge of contractual, regulatory, internal, and informational metrics, requirements, and service levels. 
• Translate business requirements to technical specifications to produce requested reporting deliverables. 
• Utilize real time reports to proactively identify potential issues to mitigate Health Plan risk.
• Participate in collaborating with internal and external business areas to maintain a current working knowledge of contractual, regulatory, internal and informational metrics, requirements and service levels.
• Complete frequent reviews of current reporting processes to ensure accuracy of data and identify opportunities for efficiencies.
• Participate in projects and assess impacts to reporting; including new report development, data/rule changes, parameter/assumption modifications and process amendments.
• Consult with stakeholders to determine appropriate course of action prior to enacting changes in reporting processes.
• Produce accurate, timely results within departmental timeframes to meet standard and ad hoc reporting needs.

Education/Experience:

• Bachelor’s Degree or equivalent work experience.
• Preferred Experience Level: 3+ years health care experience with specific experience in claims analysis and operations.
• 1 or more years health care experience with specific experience in claims analysis and operations.

Other Skills:

• Ability to analyze large data sets and make defensible recommendations
• Ability to engage and communicate with individuals at all levels.
• Demonstrated ability function autonomously and as part of a team.
• Excellent organizational, analytic and interpersonal skills required.
• General knowledge of appeals process and information flow in a managed care environment.
• Expanded analytic and technical skills.
• Clear working knowledge of MS Office Suite (including Microsoft SQL) required.
• Prior experience working with and analyzing large data sets.
• Previous experience with the Jiva system preferred.
• Previous experience with Tableau preferred.
• NCQA and DHS State reporting knowledge preferred.
• Knowledge or ability to learn Business Intelligence tools.
• Previous Healthcare or Managed Care experience.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.