AmeriHealth Caritas · 2 days ago
Supervisor Quality Auditing (Claim Audit)
Philadelphia, PA
Full-time
Hybrid
Mid Level
3+ years expAmeriHealth Caritas is a mission-driven organization specializing in healthcare solutions. The Quality Auditing Team Lead oversees the operations of the Quality Auditing department, focusing on claims auditing accuracy, compliance, and process integrity while managing multiple audit types to ensure adherence to quality standards.
Health CareInformation Technology
Responsibilities
Lead and manage claims-focused audits, including Performance Management, Compliance, Enterprise Operations, Pre‑Production, and Targeted claims audits
Apply comprehensive knowledge of claims processing rules, benefit structures, business policies, and regulatory requirements across multiple lines of business; clearly communicate audit findings and trends
Oversee the Quality Auditing appeals process, including documentation, tracking, claims-related decision review, and resolution guidance
Develop, update, and implement audit protocols, claims auditing procedures, and operational strategies to enhance accuracy and consistency
Identify system, workflow, or operational issues impacting claims quality performance; provide detailed analysis and actionable recommendations
Coordinate claims audit inventory, assignments, and special projects to ensure timely and accurate completion
Coach and mentor team members to improve claims auditing accuracy, documentation quality, and overall performance
Represent the Quality Auditing department in cross‑functional meetings related to claims operations, quality initiatives, and enterprise projects
Respond professionally to inquiries related to claims audits, appeals, and special project evaluations
Maintain thorough and compliant audit documentation and records in alignment with retention policies
Report content or system issues impacting claims auditing tools and platforms (e.g., Online Help, Facets, IAD)
Qualification
Required
Bachelor's Degree or equivalent experience
Minimum 1 year of internal quality/claims auditing experience
Minimum 3 years of healthcare or claims operations experience
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint); Access preferred
Strong analytical and problem‑solving skills, with emphasis on claims data review and error identification
Excellent communication, leadership, and collaboration skills, especially in cross‑functional claims environments
Benefits
Flexible work solutions include remote options
Hybrid work schedules
Competitive pay
Paid time off
Holidays and volunteer events
Health insurance coverage for you and your dependents starting Day 1
401(k) retirement savings plan
Tuition reimbursement
And more
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
H1B Sponsorship
AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (17)
2023 (12)
2022 (14)
2021 (4)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase