Data Reconciliation Specialist

Responsible for accurately researching and responding to Provider Check Tracer, Returned Check, OTC Member Reimbursement and Medical Member Reimbursement inquiries for all lines of business.

Reports to: Supervisor, Operations

Department: Operations

Location: Tampa, FL

Essential Functions:

  • Research the provider/member reimbursement inquiry to determine if replacement payment/reimbursement is warranted.
  • Ensure vendor and member address data is accurately reflected in our system.
  • Identify root cause of each inquiry and partner with appropriate party (provider, member, configuration, market etc.) to ensure issue resolution for all work types.
  • Process OTC Member Reimbursement requests timely and accurately.
  • Submit manual check requests to Accounts Payable.
  • Actively track and follow up on all assigned inquiries using all available tools and resources.
  • Maintain department standards for production, accuracy and quality.
  • Assists with other projects and duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 1 year of experience in Claims processing or general healthcare background. Internal candidates must also meet key performance metrics.
    • Preferred 1 year of experience in Billing, Banking, Accounting, Pharmacy and/or Appeals background
    Candidate Skills:
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Ability to work in a matrixed environment
    • Intermediate Ability to work independently
    • Intermediate Ability to work as part of a team
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Word
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Other data entry skills

        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 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.