Role Overview

The Operations Analyst is responsible for conducting root cause analysis and developing reports, studies, and data models to monitor the accuracy of benefit interpretation, claim payment, provider contract configuration, eligibility processing, and revenue-generating interfaces for the South Carolina Medicaid line of business. This role involves defining and implementing data modeling tools or reports to routinely assess existing operational processes, including benefit interpretation, claim payment accuracy, system interfaces, and integration.

Work Arrangement

Remote for South Carolina residents.  Training will take place in the North Charleston, SC office.  

Responsibilities

• Facilitate or perform root cause analysis to identify issues and improve processes for Medicaid claims. 
• Develop reports, studies, and data models related to monitoring operational accuracy
• Define and implement data modeling tools or reports to assess and improve existing operations
• Monitor the accuracy of benefit interpretation, claim payment, provider contract configuration, eligibility processing, and revenue-generating interfaces
• Ensure systems, interfaces, and integration are functioning correctly and efficiently

Education and Experience

• High School Diploma or GED required
• Bachelor’s Degree or equivalent education and experience preferred
• 3 to 5 years of healthcare claims experience preferred
• Experience in report writing, data analysis, and data research in  Medicaid managed care operations is preferred.  Medicare or Commercial background also acceptable.  

Skills & Abilities

• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint); Access is a plus

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 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’d like to hear from you.

Headquartered in Newtown Square, PA, 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.

Our Comprehensive Benefits Package

Flexible work solutions include 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.