Role Overview
Under the direction of the ACA Operations Manager, the Health Insurance Casework System Analyst is responsible to receive, triage and resolve Health Insurance Casework System (HICS) cases adhering to all CMS Federally Facilitated Marketplace Guidelines.
Work Arrangement
• Remote - Associate can work remotely anywhere in the United States
Responsibilities
• Research, follow up and resolve discrepancies associated with membership eligibility
• Analyze member eligibility and take appropriate actions to resolve issues across all systems
• Oversee, analyze and provide feedback to all areas that participate in HICS case resolution
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• Develop, implement and execute HICS training to business areas as needed
• Analyze and evaluate operations to identify and suggest process improvement
• Monitor and track HICS data
• Identify irregular trends with HICS cases; work with other areas as appropriate to identify root causes and take appropriate steps for resolution
• Document and report data to appropriate internal committees
• Make outbound phone calls in support of the HICS processes
• Must expertly understand, navigate and comply with federal regulations pertaining to written notification/letters as outlined CMS Federally Facilitated Marketplace Guidelines
Education/Experience
• High School/GED required
• Minimum of One (1) year of experience working with CMS data required
• Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization preferred
• Experience working with large data sets
• Strong knowledge of the enrollment reconciliation report process for the enrollment vendor and CMS.
Skills & Abilities
• Strong/proficient skills in Microsoft Office suite, specifically Access and Excel to extract and analyze data, and create dashboards for reporting
• Excellent communication skills
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, 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
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.
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