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 .

* This position is remote eligible but will be required to travel to our Newtown Square headquarters quarterly *

Responsibilities:

Reporting to the Director, Special Investigations Unit, the Manager, SIU Data & Analytics will work cross-functionally to create and develop creative proactive approaches to mitigating fraud. The Manager, SIU Data & Analytics oversees a team of data analysts responsible for claim quality analytics and reporting oversight. This position requires complex problem solving skills, the ability to challenge assumptions and consider alternative perspectives, the ability to think quickly and perform in high-stress situations, and operate well in a strong team environment.

Major; Accountabilities:

• Leads the enterprise excluded provider process and Member Service Verification process for Program Integrity.; This includes SIU reporting (internal & external), assisting in managing large scale projects, leading appropriate resources, and determining project requirements to ensure successful implementation to meet unit needs.;

• Interfaces regularly with various departments and management levels representing SIU objectives, assists in the creation of detailed business requirements and/or functional requirements, and assists in introducing new concepts and business processes.

• Supports claim quality initiatives and improvement efforts; prioritizes and negotiates deliverables; facilitates explanations and interpretations of reported data; be responsible for end-to-end business process activities (creation, control, and improvement of business processes through data analytics); responsible for quality analysis, reporting, supporting SIU audit deliverables, and for developing plans and programs to support continuous quality improvement using applicable tools.

• Documents and analyzes current and future processes/systems and delivery of documentation.

• Provides oversight to ensure all business process flows are documented, updated, and maintained.

• Develops or enhances a working knowledge of Managed Care Activities: Member Services, Operations Services, Claims, Provider Relations, Finance and any other functional area in order to effectively communicate with all stakeholders.

• Ensures requests are addressed promptly and courteously; honors commitments and demonstrates persistence in obtaining necessary information to address issues and problems.

• Accountable for the performance of assigned SIU data analysts.

Education/ Experience:

• Bachelor’s Degree required.;

• CHDA certification preferred.

• Possess a sound understanding of issue resolution and problem solving.

• Uses sound judgment in matters where there is established or little precedent.

• Possesses ability to effectively communicate with senior and mid-level management.

• 5 to 8 years of analytics experience with large data sets.;; Specific exposure to claims, encounter, or other patient data preferred.

Other Skills:

• Healthcare SIU Process/Systems Expertise.

• Prior healthcare experience required.; Managed Care Organization Enterprise Expertise highly preferred.

• Experience planning and tracking projects; working with large data sets and making data-driven analytical decisions; using Microsoft Excel to build reports and charts; to manipulate, sort, and filter data; and create pivot tables; using Access to build databases and trackers.;

• Exceptional time management and organizational skills; Robust analytics, advanced problem solving skills, and ability to clearly articulate ideas; explicit and concise writing; ability to explain difficult concepts; apply mathematical and statistical analysis in problem solving.;

• Ability to build high performing cohesive teams, to manage and influence others effectively in a collaborative environment at all levels of the organization.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

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.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.