Insurance OPT Jobs in Pennsylvania

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.

Role Overview:

The State Fair Hearing Administration supports the organization’s legal, compliance, and appeals functions by preparing, coordinating, and managing all administrative activities related to State Fair Hearings (“SFH”). This role facilitates timely and accurate preparation of documentation and evidentiary submissions to the Pennsylvania Department of Human Services, Bureau of Hearing and Appeals (“DHS/BHA”) while working closely with attorneys, compliance teams, case management, grievance specialists, and external agencies.

Work Arrangement:

• Hybrid - Associate must be in the office at least three (3) days per week, including core days of Tuesdays and Wednesdays

Responsibilities:

State Fair Hearing (SFH) Case Management / Coordination

• Maintain accurate logs, case files, and documentation in accordance with regulatory and contractual requirements
• Verify jurisdiction, jurisdiction-specific timeframes, and procedural requirements for each SFH Scheduled Notice received
• Schedule and coordinate SFH participation, including attorneys, witnesses, and internal stakeholders
• Maintain SFH calendars, deadlines, and status updates to facilitate compliance
• Gather evidentiary documentation for submission to DHS/BHA
• Maintain organized electronic files and submit evidentiary documentation and/or other documentation requested by DHS/BHA via the Enterprise Case Management System
• Other duties as assigned to assist with the Legal Affairs department and/or State Fair Hearing function within the department

Education/Experience:

• Associate’s or Bachelor’s degree preferred; equivalent experience considered
• 2+ years of administrative or healthcare experience managing calendars and case files required
• Strong writing skills with the ability to synthesize clinical and administrative information into clear arguments
• Exceptional organizational skills, accuracy, and ability to meet strict deadlines
• Proficiency with case management systems, appeals platforms, and Microsoft Office
• Experience supporting Medicaid managed care, state administrative hearings, or healthcare grievances and appeals
• Experience working with ALJs, state agencies, advocacy groups, and/or external counsel preferred

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.