• Amerihealth Caritas Health Plan
  • Philadelphia , PA
  • Miscellaneous
  • Full-Time
  • 1103 Market St

Responsibilities:

Under the general direction of the Director, Ops Automation, this position is responsible for all management activities related to the Automation Team within Ops Automation. This includes the automated claims processing, provider maintenance, research and analysis projects.

* Develops and directs management of Claims, Research and Analysis, and Provider Maintenance automation function to ensure claims are accurately and promptly paid within Service Level requirements.The automation activities performed by the automation team equal the work of over 300 FTE's if done manually.
* Investigate and implement automated solutions for claims processing, adjustment processing, provider record updates, Jiva updates, claim data pulls and claims financial transactions for all lines of business.
* Establish department objectives and productivity levels.
* Assists in the development of a consolidated operating budget.Makes efforts to control costs while seeking ways to increase productivity, improve quality and enhance revenue.
* Develop & execute roadmaps/time tables forautomated production updates and data management
* Direct a team of professionals including external contractors who support operations 24 hours a day, six days a week.
* Provides the technical leadership in the definition, development and maintenance of the automation tools and environments.
* This position requires frequent interaction with IS, Provider Network Management, Medical Management and Operations leadership, consultants, outside vendors, and other cross-functional team members.

Education/Experience:

* 3 to 5 years management/lead experience with demonstrated success in managing and motivating staff.
* 5 to10 years experience in healthcare, managed care or insurance industry environment required.
* IT Experience in multiple healthcare operations functions particularly a deep understanding of claims processing
* Bachelor's Degree required.
* The use of data/SQL tools, such as RapidSQL.
* Has designed, implemented or facilitated continuous integration.
* Strong knowledge of relational database theory.
* Has used automation tools to improve processes.
* Some exposure to performance testing & tools.
* Experience with HP Enterprise Testing Tool Suite and HP functional tester.
* Expert with software development life cycle.



* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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