Job Description

Position: Claims Examiner Location: Remote, United States 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. Description: The Claims Examiner reports to the Supervisor of Claims. The Claims Examiner is responsible for reviewing and adjudicating claims based on provider and health plan contractual agreements and claims processing guidelines. Responsibilities: * Complies with all internal processes and procedures to ensure activities are handled in accordance with departmental and company policies and procedures. * Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits). * Escalates claim and/or system issues to Team Lead or Supervisor. * 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 Lines 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. Education/Experience: * High School/GED required. * Associate's Degree preferred. * One to three years prior claims experience preferred. * Mathematical aptitude and analytical skills. * Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs. * Ability to research and investigate information using multiple sources and documented guidelines. * Strong interpersonal skills. * Excellent listening, verbal and written communications skills. * Excellent comprehension, reasoning and decision making skills. Company Description Welcome to AmeriHealth Caritas, the new name in health care solutions for the underserved--formerly The AmeriHealth Mercy Family of Companies. Our corporate name has changed but our mission has not. We're still the same company, dedicated to helping people get care, stay well, and build healthy communities. AmeriHealth is synonymous with innovative, cost-effective managed care solutions for publicly funded-programs. For three decades we've been a leading provider of health care for those who need it most. A higher level of care is what sets us apart. From our award-winning clinical services to our innovative outreach programs, we're making a real difference in the lives of our members. What makes us different is as personal and unique as a signature: Care is the heart of our work.

Company Description

Welcome to AmeriHealth Caritas, the new name in health care solutions for the underserved—formerly The AmeriHealth Mercy Family of Companies. \r\n\r\nOur corporate name has changed but our mission has not. We’re still the same company, dedicated to helping people get care, stay well, and build healthy communities. \r\n\r\nAmeriHealth is synonymous with innovative, cost-effective managed care solutions for publicly funded-programs. For three decades we’ve been a leading provider of health care for those who need it most. A higher level of care is what sets us apart. From our award-winning clinical services to our innovative outreach programs, we’re making a real difference in the lives of our members. \r\n\r\nWhat makes us different is as personal and unique as a signature: Care is the heart of our work.