Job Details

Job Description:

Reporting to the Supervisor of Claim Operations, the Team Lead is responsible for supporting daily claims processes and providing operational and technical support to the Supervisor.

Responsibilities:

• Serve as a technical specialist for claims operations
• Maintain up-to-date knowledge of line-of-business (LOB) processing rules, contractual guidelines, plan policies, and operational procedures
• Provide guidance to Front-End Claims Examiners and Research Analysts on complex claims issues
• Identify critical project issues and propose effective solutions
• Foster a collaborative environment that promotes teamwork, cooperation, respect, and diversity
• Build and maintain strong working relationships across multiple enterprise functional areas
• Deliver technical and peer training, including side-by-side coaching
• Prepare daily inventory reports and assist with inventory management
• Support the Supervisor with work assignments, task delegation, and meeting participation
• Participate in the OLH Processing Rule Committee
• Support Claims Leadership (Director, Manager, Supervisor) with reporting, special processes, and projects
• Act as a subject matter expert (SME) across all supported LOBs
• Assist in responding to audit findings and quality review feedback

Education & Experience:

• Associate's or Bachelor's degree preferred, or equivalent experience
• Minimum 4 years of healthcare claims processing experience required
• Knowledge of Medicaid and/or Exchange claims required
• Strong written and verbal communication skills, with excellent analytical abilities
• Demonstrated leadership experience

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