Provider Data Specialist

Supports the process to maintain the integrity of the provider network data by preforming online research and/or conducting phone validations and updating source systems with accurate information.

Essential Functions:
  • Supports requests for assistance and researches issues using various resources
  • Communicates clearly, written and verbal, and follows up with various areas to ensure tasks are completed or issues are escalated appropriately
  • Analyzes trends to recommend process and/or operational improvements
  • Performs quality checks throughout the directory process and third party vendor process to ensure accuracy in the data
  • Assists with audit reviews for accuracy and provide timely feedback on findings
  • Participate in cross-functional departmental planning sessions
  • Perform all other related duties as assigned by manager
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 1 year of experience in research analysis
    Candidate Skills:
    • Advanced Ability to multi-task
    • Advanced Demonstrated organizational skills
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Other Requires strong project tracking
    • Intermediate Other Requires solid analysis and research skills to resolve various provider related issues
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Advanced Microsoft Excel
      • Required Advanced Microsoft Word
      • Required Advanced Microsoft Outlook
      • Required Intermediate Microsoft Access
      • Required Intermediate Microsoft PowerPoint

        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.