Cost of Benefits Solutions Manager

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Role Overview The Cost of Benefits (COB) Solutions Manager works directly with internal and external stakeholders including but not limited to Operations, Vendors, Provider Network and IS in the identification of COB overpayment and operational process improvement opportunities. This manager will lead the development and utilization of any internal/external tools to assist in COB processing and recovery. In addition, this role assists Fraud, Waste, and Abuse [FWA] with predictive analytics and trend reporting. A successful candidate will have very strong analytical skills, be comfortable with SQL, have strong communication skills and have a passion for using data to drive business decisions and cost savings. Work Arrangement This is a 100% Remote position but you must live in EST or CST time zones

Responsibilities

Technical: Will be the point of contact for any global IS issues impacting COB processes. Including but not limited to internal/external file transfers, Facets updates, TPL data load logic, PMO related projects. Responsible for vendor data file layout version control and definitions Will coordinate any technical calls with IS to support our vendor partners to ensure their success Point of contact for solutioning impacts of new business requirements coming from existing plans. This includes coordinating with departmental peers. Develop process improvement initiatives to present to senior leadership Represent the department for any ISCA audits or report development Will lead the development and utilization of any internal/external tools to assist in COB processing and recovery Reporting Act as the SME regarding TPL Dashboard reporting requirements Develop ad hoc analysis at senior leadership request. (ROI, CBA etc.) Responsible for any outside ad hoc reporting development or validation Point of contact for any TPL data reconciliations (TPL data source system vs. sub-cons) Other Maintain accurate SOP for any recurring internal reporting (inventory reporting etc.) Point of contact for TPL inventory data feeds to WFM Recruit, develop, and motivate staff. Continuously improve skill knowledge and staff capabilities Education and Experience: Bachelor’s Degree and five to ten (5 – 10) years’ experience Knowledge of claims processing systems; Facets claims system a plus. SQL query experience Knowledge of COB processing rules for Medicaid and Medicare. Familiarity with SDLC as it relates to developing new systems Knowledge of subrogation case rules and regulation for Medicaid, Medicare, and Exchange products Ability to develop reports or take existing reports with KPIs and create actionable plans for overall end to end improvements for TPL and Subrogation processes 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. 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.