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Your career starts now. We’re looking for the next generation of healthcare 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 healthcare 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.

**Position Overview:** The Health Insurance Data Strategist plays a critical role in driving data-informed decision-making to enhance performance across Specialty Products and Networks. This role combines deep analytical expertise, technical proficiency in healthcare data, and strategic thinking to support product innovation, operational efficiency, and improved health outcomes. The strategist will utilize advanced analytics, predictive modeling, and business intelligence to generate insights that shape strategy and foster innovation.

Key Responsibilities:

Strategic Analytics & Insight Generation:

+ Design and implement data-driven strategies to improve financial outcomes, operational performance, and care quality across Specialty Products.

+ Analyze Medicare and Medicaid claims, enrollment, risk adjustment, and provider network data using SQL and/or SAS.

+ Apply predictive modeling and statistical analysis to uncover trends, assess risks, and identify growth opportunities.

+ Develop and document business rules and methodologies for claims analysis and performance tracking.

Technical & Analytical Leadership:

+ Integrate and analyze large, complex datasets from multiple sources (claims, financials, provider networks, SDoH, etc.).

+ Apply advanced analytics techniques, including AI and statistical modeling, to support key business initiatives.

+ Conduct root cause analysis on claims issues such as denials, delays, and discrepancies to ensure accuracy and detect anomalies or fraud.

+ Build and maintain dashboards and reports using BI tools (e.g., Tableau, Power BI, Looker) to support decision-making and stakeholder engagement.

+ Partner with IT and data engineering teams to ensure data quality, governance, and regulatory compliance (HIPAA, CMS, etc.).

Performance Optimization & Innovation:

+ Identify and implement opportunities for automation, process improvement, and operational efficiency.

+ Monitor industry trends, emerging technologies, and regulatory changes to ensure strategic alignment and compliance.

+ Support system upgrades and migrations related to claims processing and data infrastructure.

Education & Experience:

+ Bachelor’s degree in Healthcare Administration, Computer Science, Data Analytics, Business, or a related field.

+ 5 plus years of experience in healthcare or managed care, focusing on data analytics or strategy.

+ Proven experience in healthcare claims analysis and advanced analytics, including data suspecting and predictive modeling.

+ Proficiency in SQL (T-SQL, PL/SQL) and/or SAS; experience with BI tools such as Tableau or Power BI.

+ Strong ability to interpret complex data and communicate insights to non-technical stakeholders.

+ Familiarity with ETL processes, data validation, and data governance best practices.

+ Strong analytical, problem-solving, and communication skills.

+ High attention to detail and ability to manage multiple priorities in a fast-paced environment.

+ Ability to influence stakeholders, present data-driven recommendations, and drive strategic initiatives.

+ Experience working in regulated environments and developing standards for compliance.

Preferred Qualifications:

+ Experience with healthcare claims adjudication systems (e.g., Facets, Amisys, QNXT, Epic).

+ Knowledge of Medicare/Medicaid billing codes (ICD-10, CPT, HCPCS) and reimbursement methodologies.

+ Familiarity with predictive analytics, machine learning, and risk adjustment models.

+ Understanding of CMS regulations, HIPAA, and healthcare data security standards.

+ Experience with managed care organizations (MCOs) and provider network analytics.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.; We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include 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.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.