Claims Specialist for WellCare Health Plans

The Job —  Claims Specialist for WellCare Health Plans

Location —  Telecommute available after 90 days upon review.

Job Responsibilities —  From the company job posting:

  • 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.

Requirements/Qualifications

  • 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
  • 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

Schedule —  Full time, flexible

Employee or Contract — Employee

Compensation — Not advertised.   Click here for Glassdoor salary reviews.

Benefits — Full benefits offered.

More Information — Review and apply by clicking here.