AmeriHealth Caritas · 1 day ago
Claims Examiner
United States
Full-time
Remote
Entry Level
1+ years expAmeriHealth Caritas is a healthcare organization, and they are seeking a Claims Examiner to review and adjudicate claims based on provider and health plan contractual agreements. The role involves processing complex healthcare claims and ensuring compliance with departmental policies and quality standards.
Health CareInformation Technology
Responsibilities
Complies with all internal processes and procedures to ensure activities are handled in accordance with departmental and company policies and procedures
Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits)
Escalates claim and/or system issues to Team Lead or Supervisor
Creates and supports a professional environment which fosters teamwork, cooperation, respect and diversity
Meet department quality and production requirements
This position is required to meet and maintain performance goals established for the position in the areas of quality and production
Process claims for multiple Lines of Business as requested by management
Understands processing rules for multiple lines of business and supports other lines of business as needed to meet business needs
Qualification
Required
High School/GED required
1 to 3 years prior claims experience
Mathematical aptitude and analytical skills
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and leaning new computer programs
Ability to research and investigate information using multiple sources and documented guidelines
Strong interpersonal skills
Excellent listening, verbal and written communications skills
Excellent comprehension, reasoning and decision making skills
Preferred
Associate's Degree preferred
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