Configuration Auditor/Analyst Sr

Your career starts now. We’re looking for the next generation of health care 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 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’d like to hear from 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 www.amerihealthcaritas.com.

Role Overview: The Senior Configuration Quality Auditor serves as a technical subject matter expert in the Quality Auditing department and is responsible for executing and documenting complex audit activities in accordance with established audit methodology.

Responsibilities:

• Audit enterprise-wide, high-impact, time-sensitive, and complex Facets configuration changes and projects.
• Validate production configurations to ensure accurate case migration and support the Post-Implementation Review (PIR) process.
• Triage and resolve complex configuration-related inquiries and collaborate with configuration auditing team members to ensure consistency and accuracy.
• Proactively research, analyze, and test claims payment methodologies to identify potential issues or risks.
• Conduct data analysis and data mining activities, clearly documenting findings, issues, and recommendations.
• Develop, document, and maintain auditing processes and procedures to support team training and education.
• Communicate effectively and professionally with configuration teams to ensure accuracy, compliance, and adherence to established timelines.
• Provide coaching, training, and constructive feedback to associates as needed to support skill development and quality outcomes.
• Represent the team in meetings and cross-functional discussions as required.
• Identify opportunities to improve processes, enhance efficiency, quality, and operational effectiveness.

Education & Experience:

• Associate’s Degree preferred, or equivalent combination of education and experience.
• 1 to 3 years of internal Configuration Quality Auditing experience required.
• 3 to 5 years of experience in system configuration and Microsoft Access.
• Strong working knowledge of Facets claims processing required.
• Healthcare industry experience required.
• Experience with data analysis and data mining is strongly preferred.

Skills & Abilities:

• Advanced analytical and problem-solving skills with strong attention to detail.
• In-depth knowledge of Facets configuration and claims processing methodologies.
• Ability to interpret complex configuration requirements and audit results accurately.
• Strong written and verbal communication skills, with the ability to convey technical information clearly to diverse audiences.
• Proven ability to work independently on complex audits while collaborating effectively within a team environment.
• Strong organizational and time management skills, with the ability to manage multiple priorities and meet tight deadlines.
• Proficiency in Microsoft Access and other data analysis tools.
• Ability to coach, mentor, and support peers in a quality-driven environment.

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.