Supervisor of Claims Processing

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 1.4 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 Claims Processing Supercisor to our Operations 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 directing the daily work assignments of associates assigned to the unit.  Also is the technical expert for all products assigned to the unit.

 

Essential Functions:

 

?  Oversees daily work assignments of up to 10+ associates.

?  Monitors daily performance of associates, inventory levels, phone stats, pend reports in order to ensure accurate and timely processing of claims and provider call.

?  Provides regular feedback to associates on performance.

? Thoroughly researches pended claims and/or provider issues that have been forwarded to them and takes appropriate action to resolve them within turnaround time requirements and quality standards.

?  Communicates with Provider Relations and provider office staff to resolve service issues. 

?  Participates in all formal and informal training opportunities.

?  Able to resolve complex claims issues.  Subject matter expert to team.

?  Acts as manager when manager is absent.  Assist with special projects as directed by manager.  Identify opportunities to improve provider services processes.   Oversees progress of new claims processors & claim service representatives.

 

Knowledge, Skills, Abilities Required:

 

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

 

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