Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is seeking a Provider Network Operations Supervisor to oversee the daily operations and performance of its Provider Network Operations team. The role supervises staff, ensures compliance with policies and contractual requirements, resolves provider and claims-related issues, and supports process improvements.
Responsibilities
- Supervise, coach, and monitor staff performance to ensure quality and timely completion of work
- Support the Manager in implementing departmental initiatives and process improvements
- Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)
- Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes
- Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement
- Research and resolve complex claims issues and operational discrepancies
- Identify operational challenges and recommend solutions to improve performance and compliance
- Participate in special projects and perform additional duties as assigned
Skills
- • Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI
- • Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
- • Associate degree required or equivalent combination of education and relevant work experience
- • Strong leadership and team development capabilities
- • Knowledge of healthcare operations, particularly claims and provider data
- • Analytical and problem-solving skills with attention to detail
- • Ability to manage multiple priorities in a fast-paced environment
- • Strong communication and interpersonal skills
- • Ability to identify process improvement opportunities and drive change
- • 1 to 3 years of supervisory or leadership experience preferred
- • Experience in managed care or a healthcare environment preferred
- • Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred
- • Familiarity with Medicaid reimbursement methodologies preferred
Benefits
- This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
- Internet reimbursement may be available where required by law or contract
Company Overview
Company H1B Sponsorship