Configuration Data Specialist

Location: Phoenix, AZ Office

Reports to: Supervisor, Configuration

To ensure accurate and timely loading and maintenance of provider file information through appropriate research. This would include, but not be limited to: initial loads based on claim receipts, provider demographics, vendor information, terminations, and researching, analyzing and making appropriate adjustments to the daily departmental reports.

Essential Functions:

  • Performs accurate and timely provider research, verification and analysis. Including verification of license status utilizing designated web pages when new providers are added to the system.
  • Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
  • Resolves provider load issues within established documented processes.
  • Ensures the proper supporting documentation exists and is maintained on file for all load processes.
  • Loads and maintains provider data.
  • Responds to inquiries from provider field staff,
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Responsible for building and maintaining positive business relationships with business partners.
  • Assists in special projects.
  • Maintains high quality work.
  • Meets productivity expectations.
  • Works Auto Analyzer Reports.
  • Performs other duties as assigned
  • Completes assignments thoroughly, accurately and on time.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 1 year of experience in health insurance
    Candidate Skills:
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated analytical skills
    • Intermediate Demonstrated problem solving skills
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Other Knowledge of Claims Processing
    • Intermediate Other Basic understanding of provider types and specialties
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Preferred Intermediate Other Knowledge of CPT/HCPCS coding
      • Preferred Intermediate Other Knowledge of provider billing practices
      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.