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Wellcare

Grievance Coordinator

Wellcare - Tampa, FL

Grievance Coordinator','1706281','!*!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.','!*!

LOCATION:  W. Idlewild Avenue, Tampa, FL 33634

DEPARTMENT:  Operations – Complaint Resolution  

REPORTING TO:  Supervisor, Operations

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.

Essential Functions:

Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.

Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.

Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative.

Assists in the education of new members and in the re-education of existing members regarding health plan procedures.

Track grievance case by line of business for compliance and review.

Assist in resolving member and provider complaints

Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.

Demonstrates based behaviors such as initiative, accountability and value.

Performs skills necessary to create a high-quality customer experience, as reflected through acceptable  quality audit score and productivity.','!*!

Education:  High School Diploma required, associates degree preferred    

Experience:  1-3 years experience within a call center or customer service environment

1 year Grievance experience preferred

Experience within a health care company preferred

Licenses/Certifications:  Customer service, quality or training certifications (preferred)

Special Skills (e.g. 2nd language): 

Strong written and verbal communication skills and an ability to work with people from diverse backgrounds

Ability to multi-task, good organizational and time management skills

Ability to act on feedback provided by showing ownership of his or her own development

Ability to read, analyzes, and interprets verbal and written instructions

Ability to write business correspondence

Ability to effectively present information and respond to questions from members

Ability to define problems collects data, establish facts and draw valid conclusions

Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication

Technical Skills/Requirements: 

Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contactsKnowledge of Word and/or Excel sufficient to enter data','US-FL-Tampa','5519 Idlewild Ave','','Tampa','33601','','','No','No','Grievance Coordinator'

5 days 1 hour ago

Wellcare

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Grievance Coordinator Wellcare - Tampa, FL, United States

   

Location: Tampa, FL

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.