Legal Supt Asst -Prov Disputes

Responsible for working with the Litigation team in researching, analyzing and working with key business teams to support litigation and other disputes related to provider claims payments and payment models.

Reports to: VP, Litigation, Reg & Health Pln Ops
Department: Legal
Position Location: Tampa, FL 33634 or Chicago, IL (with possible Remote opportunities)

Essential Functions:

  • Support in-house attorneys, through research, analysis and critical thinking, on analyses of provider litigation and disputes to minimize organizational loss.
  • Lead legal/fact research and early assessment of disputes involving provider payments and related claims and contract issues
  • Work with attorneys, outside counsel, Legal Operations teammates and clients on discovery in litigated matters
  • Collaborate and communicate effectively and professionally across internal and external stakeholders to work up and resolve matters.
  • Identifies opportunities and solutions to improve departmental results, communications and operating efficiencies.
  • Assists on other litigation matters and projects as needed.
  • Perform other duties and work on projects as assigned.
Additional Responsibilities: Candidate Education:
  • Required An Associate's Degree in Legal, Business, Finance, Accounting or related field
  • Preferred A Bachelor's Degree in Legal, Business, Finance, Accounting or related field
  • Preferred Other Claims/Coding certification or study
  • Preferred Other advanced certification in legal profession
Candidate Experience:
  • Required 5 years of experience in Related experience in a legal or provider/network/disputes department of a Managed Care Organization or Provider Network analyzing claims payments and/or provider disputes.
  • Preferred 2 years of experience in Health care/health insurance, or other insurance-related litigation, with Medicaid and Medicare payment experience
Candidate Skills:
  • Intermediate Ability to communicate and make recommendations to upper management
  • Intermediate Ability to drive multiple projects
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Ability to influence internal and external constituents
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated written communication skills
  • Intermediate Knowledge of healthcare delivery
  • Intermediate Demonstrated problem solving skills
  • Intermediate Demonstrated analytical skills
  • Intermediate Ability to work independently
  • Intermediate Ability to work within tight timeframes and meet strict deadlines
  • Intermediate Demonstrated negotiation skills
  • Intermediate Ability to work in a matrixed environment
  • Intermediate Ability to analyze information and convert related activities into a comprehensive work plan
Licenses and Certifications:
A license in one of the following is required:
    Technical Skills:
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Word
    • Required Intermediate Other Emptoris or other contract management software experience

      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.