About this role
Role Overview:
The Manager of Claims is responsible for overseeing and coordinating operational activities within the Claims Unit, including claims processing, provider claims services, research, and projects.
- Manages day-to-day departmental operations and ensures priorities and tasks are completed accurately and on time.
- Identifies and resolves operational issues using established processes, subject matter expertise, and sound judgment.
- Ensures departmental performance standards and Service Level Agreements (SLAs) are consistently met.
- Coaches and develops team members to meet or exceed individual and departmental performance goals.
- Monitors employee performance and makes recommendations and decisions regarding promotions and disciplinary actions.
- Assists with the development and management of the department's operating budget.
- Identifies opportunities to control costs, increase productivity, improve quality, and enhance revenue.
- Manages the hiring and onboarding of operations associates.
- Provides ongoing coaching, career development, and professional development opportunities for new and existing team members.
- Maintains knowledge of industry trends, regulatory requirements, and developments within areas of responsibility and communicates relevant updates to the team.
- Supports and manages internal and customer-initiated audits, regulatory reviews, and customer certifications, including HEDIS and NCQA.
- Manages operational programs and reporting to identify opportunities to improve production, quality, and overall performance.
- Partners with Workforce Management to ensure staffing resources are appropriately allocated based on production needs and SLA requirements.
Education & Experience
- Bachelor's degree or equivalent combination of education and relevant work experience required.
- Minimum of 3 years of experience in healthcare, managed care, or the insurance industry required.
- Minimum of 5 years of management experience required.
- Previous claims management experience required.
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 starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us: 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 are driven to make a difference, we want to hear from you.
About AmeriHealth Caritas
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com