Coordination of Benefits Specialist*

Initiates contact to other insurance companies to gather coordination of benefits (COB) data. Consolidates the activities that support the collection, management and reporting of other insurance coverage. Additionally, provides outreach screening services for WellCare Medicare members who are potentially eligible for benefits through the Medicare Savings Program (MSP). Provides necessary telephone support for various Medicaid and Medicare programs.

Location: Idlewild Ave, Tampa, FL

Department: Ops-Payment Integrity

Reporting to: Supv, Coordination of Benefits

Essential Functions:

  • Responsible for investigating and validating potential Third Party Liability (TPL) / Coordination of Benefits (COB) instances for WellCare membership.
  • Validates primary insurance coverage for claims received by WellCare with attached EOBs.
  • Maintains accurate member COB information within Xcelys and COB application.
  • Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
  • Performs skills necessary to create a high-quality stakeholder experience, as reflected through acceptable quality audit score and productivity.
  • Conducts outreach phone calls and initial MSP eligibility screenings to potentially eligible members, Deeming members, and their families.
  • Prepares information packets and Medicaid applications to mail to MSP eligible members.
  • Submits Medicaid applications to state-agencies on behalf of members, when requested by member.
  • Answers incoming calls from members, Customer Service, Case Managers and Benefits Consultants and provides information related to Medicare Savings Program, Extra Help Program, Medicaid status, Medicaid eligibility screening, and D-SNP Deeming status.
  • Tracks status of MSP applications and approvals for accurate reporting to Finance, Special Populations, Case Management and Product/Sales teams.
  • Answers incoming phone calls from Pre-Enrollment, Benefit Consultants or 1099 staff for Medicaid Verification.
  • Provides Medicaid, Medicare and Low Income Subsidy (LIS) eligibility details to inbound caller and documents in SalesForce.
  • Verifies Medicaid eligibility for any paper applications received by WellCare.
  • Assists in the validation of continued DSNP eligibility for all current DSNP membership.
  • Performs special projects, as requested by management.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred An Associate's Degree in a related field
    Candidate Experience:
    • Required 1 year of experience in a call center or customer service environment
    • Preferred Other Experience within a health care company
    Candidate Skills:
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to multi-task Ability to multi-task, good organizational and time management skills
    • Intermediate Demonstrated organizational skills
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Ability to effectively present information and respond to questions from peers and management Ability to effectively present information and respond to questions from management or other internal associates
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Ability to define problems collects data, establish facts and draw valid conclusions
    • Advanced Demonstrated customer service skills Demonstrates appropriate customer-care skills
    • Intermediate Other Ability to act on feedback provided by showing ownership of his or her own development
    • Intermediate Other Ability to read, analyze, and interpret verbal and written instructions
    • Intermediate Other Ability to write business correspondence
    • Intermediate Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
    • Intermediate Other Ability to work with people from diverse backgrounds
    • Intermediate Other Perform skills necessary to create a high-quality stakeholder experience, as reflected through acceptable quality audit score and productivity
    • Intermediate Other Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Other Customer service, quality or training certifications
    Technical Skills:
    • Required Beginner Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
    • Required Beginner Microsoft Word Knowledge of Word and/or Excel sufficient to enter data
    • Required Beginner Microsoft Excel
    Languages:

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. 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.