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.

Responsibilities:

Reporting to the Director, Corporate Appeals, this position is primarily responsible for supporting Appeals Technology initiatives from initiation through stabilization; including the following responsibilities:  

• Connect Business Requirements with current and new technology solutions. Develop Business Requirements to meet Appeals systems and process user needs.
• Accountable for understanding software and systems modifications to ensure successful implementation and communicate appropriately to all areas of the Organization.
• Possess a working knowledge of all Managed Care Activities and current AmeriHealth Technology. 
• Builds consensus among primary users, Appeal leadership, I.S. Department,  and all levels of Appeal associates as they relate to system related advancements, business problems, and issues.  
• Demonstrates strong problem solving capabilities and approaches each problem in a logical and analytical manner with high degree of perseverance.
• Displays the ability to anticipate and be responsive to management needs and exercise proper judgment. 
• Communicates effectively and serves as central point of contact for all Technology Related Appeal Business Requirements.
• Accountable for meeting the defined delivery time for projects, and quality commitments.
• Assists with the development of presentations.
• Assists with Testing of requirements. 
• Develops recommendations for improving the efficiency and performance of processes.
• Seeks integration opportunities of core processes to be utilized by all areas of Appeals.
• Initiates continuous improvement of project activity through metric driven triggers.
• Responsible for oversight of all associated Appeal System releases.
• Strong team player who operates effectively in a team environment as well as individually.
• Maintains consolidated reporting for Appeals Management, Project Leads, Stakeholders, Project Managers and can include milestone summaries, key issues, risks, benefits, and individual status reports.

Education/Experience:

• Bachelor’s Degree Management Information Systems or related field or eight years of related work experience.
• Minimum 3 years progressive experience in business systems Analysis / project management and Technology concentration.
• Minimum 3 years direct user interface experience.
• Experience with IAD, ICR, Verint, ACYUS, Jiva.
• Experience with Technology life cycle development.
• Knowledge of Appeals & Grievance Coordinators needs and requirements for success in their role.
• Possess solid understanding of Medicaid Business Process; sound understanding of organizational and process development.
• Critical thinking skills.
• Ability to translate technical concepts & information to non-Technical Stakeholders.
• Strong analytical skills and attention to detail.
• Strong conceptual skills.
• Ability to identify, analyze, and resolve problems logically and systematically.
• Ability to effectively communicate technical information verbally as well as in written formats.
• Ability to maintain consistent service levels as identified.
• Ability to meet deadlines and handle varying workloads with a high degree of accuracy.

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.