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Claims Specialist II

Wellcare - Phoenix, AZ

Claims Specialist II','1705302','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at or view our videos at All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!

This position is for Care1st Health Plan in Phoenix, AZ, a WellCare Healthplans, Inc. company.

Researches and processes institutional and professional claims. Serves as a mentor to less experienced associates and acts as a resource to resolve more complex claims.

Department: Arizona- Operations Claims-Medicaid

Reports to: Supv, Operations

Location:  E Camelback Rd, Phoenix AZ 85016

Job Type: Hourly/Non-exempt

Essential Functions:

Processes claims that pend for various hold reasons to assist in the final determination on claim disposition.

Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs.

Researches complex claims issues and works with all external departments, markets, and providers on claims related content.

Completes new hire audits.

Runs and analyzes ad-hoc reports.

Identify root-cause issues to ensure enterprise solutions and communicate findings as needed.

Participates in all formal and informal training opportunities.

Assists with special projects as assigned or directed. Additional Responsibilities:

Arizona representatives may provide provider phone coverage two days a week ','!*!Candidate Education:

Required A High School or GED Candidate Experience:

Required 2 years of experience in Previous claims or health insurance (for external candidates)

Required 6 months of experience in Institutional and / or professional claims Candidate Skills:

Intermediate Ability to communicate and make recommendations to upper management

Intermediate Ability to multi-task

Intermediate Ability to work independently

Intermediate Ability to work in a fast paced environment with changing priorities

Intermediate Demonstrated analytical skills

Intermediate Demonstrated customer service skills

Intermediate Demonstrated organizational skills

Intermediate Demonstrated time management and priority setting skills

Intermediate Demonstrated written communication skills

Intermediate Demonstrated interpersonal/verbal communication skills

Intermediate Demonstrated problem solving skills Technical Skills:

Required Intermediate Microsoft Outlook

Required Intermediate Microsoft Word

Required Intermediate Microsoft Excel ','US-AZ-Phoenix','2355 E. Camelback Dr.','Suite 300','Phoenix','85016','','','No','No','Claims Specialist II'

15 days 23 hours ago



Claims Specialist II Wellcare - Phoenix, AZ, United States


Location: Phoenix, AZ

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.