Claims Specialist IIWellcare - Tampa, FL
Claims Specialist II','1704978','!*!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 www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: 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.','!*!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. 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 Licenses and Certifications:A license in one of the following is required:
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel Languages:
','US-FL-Tampa','5301 West Idlewild Avenue','Tampa International Business Center','Tampa','33634','','','No','No','Claims Specialist II'
9 days 21 hours ago
applyClaims Specialist II Wellcare - Tampa, FL, United States
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.
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