AmeriHealth Caritas Claims Pricing Product Consultant - NetworX Pricer / Optum in Philadelphia, Pennsylvania

Claims Pricing Product Consultant - NetworX Pricer / Optum

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14243

Job Brief

Manage the Claims Pricing products and lead the technical implementations of strategic Business and IS initiatives in Healthcare Payer Core Admin/Claims platform

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 Philadelphia, 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 .

The Application Technical Lead Senior will manage the Claims Pricing products and lead the technical implementations of strategic Business and IS initiatives in Healthcare Payer Core Admin/Claims platform.

Responsibilities include the following:

  • Function as a lead to manage the Claims Pricing product suite including NetworX Pricer, Optum and 3M products.

  • Manage and Implement the releases of Optum Rate Manger, ECM Pro, WebStrat and Regulatory Changes, 3M GPS and CGS.

  • Manage relationships with Vendors, IS Departments and Configuration teams.

  • Document the current state system architecture and maintain them ongoing basis.

  • Function as a solution lead/architect for business and IS initiatives.

  • Lead the design and implementation of solutions for Healthcare Payer Core Admin/Claims platform.

  • Lead, evaluate and provide technical and architectural guidance to team members.

  • Work collaboratively with architecture teams to ensure that the proposed solution is aligned with enterprise architecture standards, guidelines and principles.

  • Lead solution architecture for application enhancements.

  • Function as the point person for overall technical solution by aligning dependencies based on enterprise, data and application architecture.

  • Carries out systematic problem identification, analysis, and resolution.

  • Analyzes and reduces complex problems into simple, manageable components.

  • Develops technical design specifications.

  • Participate in and/or lead code reviews.

  • Mentor and coach technical development team.

  • Establish best practices, standards, tools to optimize design and development.

  • Ensure that Software Development Methodologies in design and build are consistently implemented and tracked with appropriate metrics.

  • Manage client expectations and escalations. Demonstrate commitment to outstanding customer service. Must be adept at managing multiple priorities under time constraints.

Skills Required:

  • At least six years of IS experience. A minimum of three years of prior experience in the Healthcare industry.

  • Knowledgeable in Architecture governance practices.

  • Knowledgeable in the design and construction of integrated transactional & collaborative enterprise-level systems that are scalable and portable.

  • Knowledge of all phases of software development for large-scale business critical applications in both Waterfall and Agile methodologies.

  • Understanding of Object-Oriented techniques.

  • Ability to understand the long-term ("big picture") and short-term perspectives of situations.

  • Strong knowledge in Sybase or SQL Server.

  • Experience in designing / developing applications using Microsoft .Net.

  • Unix / Linux experience.

  • Experience in Tidal scheduler.

  • Experience in designing solutions using IBM Data Stage.

  • Knowledge in a Healthcare Payer Core Admin platform, such as Trizetto Facets, QNXT and Diamond.


  • Bachelor's Degree or equivalent work experience.

EOE Minorities/Females/Protected Veterans/Disabled