Senior Claims Specialist

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation?s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve 2 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

We are looking to add a Senior Claims Specialist to our Provider Service Center team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be a part of a dynamic, growing organization, then this may be the opportunity for you.

 

 

Job Summary:

Position is primarily responsible for processing institutional and professional claim adjustments.

 

Essential Functions:Thoroughly researches claim projects and takes appropriate action to resolve them within turnaround time requirements and quality standards.  Works Institutional and Professional Claim Projects/AdjustmentsDevelops claims that require additional information in order to make a final determination on the disposition of the claim.  Participates in all formal and informal training opportunities.Able to resolve complex claims issues.

 

Additional Duties:Assist with special projects as directed by supervisor.Identify opportunities to improve claims processes. Act as a mentor to new claims processors. All other duties as assigned.

 

Supervision Received/Exercised:Close supervision through daily, weekly, and monthly monitoring through reports, audits, and supervisory observation.

 

Scope of Decisions:Adheres to all departmental, regulatory, and organizational Policies and Procedures.

 

 

 

Knowledge, Skills, Abilities Required:

Education/Experience: (include any licenses or certifications required)High school diploma or equivalent.2 years claims processing experience.

 

Communication and Numeric Skills:Strong customer service skills Oral and written communication skills sufficient to clearly convey messages to co-workers, supervisor, others in the organization, and to our customers.Interpersonal skills required to work well with others.Ability to follow direction.

 

Computer Skills:Skilled in the use of a PC.Skilled in the use of WellCare computer systems or similar claims processing systems.

 

Physical Demands:Ability to work on computer for extended period of time.Ability to sit for extended periods of time and to move around the office as needed. 

 

Other:Ability to work individually and as part of a team.  Ability to work in a fast paced environment with changing priorities.Ability to work overtime as required.Ability to organize tasks and work environment for efficient use of time. 

 

Working Conditions:

Climate controlled office environment.