• Quality Auditing Team Lead

    AmeriHealth Caritas (Philadelphia, PA)


    Role Overview

     

    The Quality Auditing Team Lead oversees daily operations of the Quality Auditing department and manages multiple audits—including Performance Management, Compliance, and Operational reviews—to ensure adherence to quality standards across AmeriHealth Caritas. This role also supports special projects and analytical initiatives to drive continuous improvement.

    Key Responsibilities

    + Lead and manage audits: Performance Management, Compliance, Enterprise Operations, Pre-Production, and Target audits.

    + Apply comprehensive knowledge of business rules, policies, and procedures across multiple lines of business; communicate findings clearly.

    + Oversee Quality Auditing appeals process: documentation, tracking, decision-making, and resolution guidance.

    + Develop and implement protocols, policies, procedures, and operational strategies for Quality Auditing programs.

    + Identify system or operational issues impacting quality performance; provide analysis and recommendations.

    + Coordinate audit inventory, tasks, and projects to ensure timely completion.

    + Coach and provide feedback to team members to improve accuracy and performance.

    + Represent Quality Auditing in meetings and cross-functional initiatives.

    + Respond professionally to inquiries related to audits, appeals, and special projects.

    + Maintain audit documentation and records per retention policies.

    + Report content or system issues related to audit tools and platforms (e.g., Online Help, Facets, IAD).

    Education & Experience

    + Bachelor’s Degree or equivalent experience.

    + Minimum 1 year of internal quality auditing experience.

    + Minimum 3 years of healthcare industry experience.

    + Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint); Access preferred.

    Skills & Abilities

    + Strong analytical and problem-solving skills.

    + Excellent communication, leadership, and collaboration skills.

     

    Our Comprehensive Benefits Package

     

    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.

     

    **Why Join Us:** Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are 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 are driven to make a difference, we want to hear from you.

     

    About AmeriHealth Caritas

     

    Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at http://www.amerihealthcaritas.com

    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.