Claims Specialist I

Location: Idlewild Ave, Tampa, FL

Reporting to: Supv, Operations

Department: Ops-Claims

Researches and processes institutional and/or professional 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.
  • Researches post payment claims issues and takes necessary action for correction.
  • Research claims issues and works with other departments to resolve claim issues.
  • 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:
  • Preferred 1 year of experience in Previous claims or health insurance
Candidate Skills:
  • Beginner Ability to multi-task
  • Beginner Ability to work independently
  • Beginner Ability to communicate and make recommendations to upper management
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Beginner Demonstrated written communication skills
  • Beginner Demonstrated analytical skills
  • Beginner Demonstrated problem solving skills
  • Beginner Demonstrated time management and priority setting skills
  • Beginner Demonstrated organizational skills
  • Beginner Knowledge of healthcare delivery
Licenses and Certifications:
A license in one of the following is required:
    Technical Skills:
    • Required Beginner Microsoft Outlook
    • Required Beginner Microsoft Word
    • Required Beginner Microsoft Excel
    Languages:

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.