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Third Party Verification Specialist
3 months ago
Third Party Verification Specialist
Location: Philadelphia, PA
Primary Job Function: Compliance
ID**: 34270
Your career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care 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 would like to hear you.
Headquartered in Newtown Square, 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
Responsibilities:
TPL data is critical to ensure that ACFC is the payer of last resort.
Under the supervision of the Manager and Director of Payment Integrity Operations, the TPL Specialist is responsible for investigating, updating and communicating to state, vendor, and internal/external departments, Plan Member Third Party Liability (TPL) information for all Lines of Business.
Effectively navigates, disseminates, and updates information in the ACFC Healthcare System.
Accurately reviews state and vendor disposition reports to determine if manual entry of TPL data required.
Education/Experience:
- High School/GED.
- Associate's Degree preferred.
- Excellent Data-Entry skills to document findings.
- Proficient in Microsoft Office applications.
- Effectively investigate Plan Member Other Insurance coverage information via websites and direct calling to the Insurer.
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 including 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.
EOE Minorities/Females/Protected Veterans/Disabled
