Disability Claims Examiner, Sr. jobs in New Hampshire

Your career starts now. We are looking for the next generation of health care 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 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 would like to connect with 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.

The Provider Network Operations Data Analyst Senior supports the business goals and initiatives of the Provider Network Operations department. This role is responsible for:  

• UAT/Client Review & audit (fee schedule concentration) – reviews requests prior to initial submission to EO and claims post-production 
• Capitation reconciliations – building queries, comparing membership; engaging with Finance, PNM, etc.
• Internal business report development; engagement with regulatory reporting
• BAM/claim reporting submission and analysis, depending on complexity
• Administrative responsibilities:
  • Performs other duties and projects as assigned
  • Adheres to Plan policies and procedures
  • Attends required training sessions on an annual basis.

Education/ Experience: 

• Bachelor’s Degree or equivalent work experience 
• 3 to 5 years Data modeling, relational databases and advanced analytics support required. Experience in healthcare industry preferred 
• 3 to 5 years exp. With data modeling, relational databases and advanced analytics support required.
• Experience with Medicaid preferred. 
• Experience with Microsoft Excel. 

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.