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Corporate Functions & Operations WellCare - Claims Careers

Claims Account Relations Specialist Job

Full Job Title: Claims/Account Relations Specialist

Job Number: 1702244

Location: Tampa, FL

Date Posted: 5-16-2017

LOCATION: Idlewild Avenue, Tampa, FL
DEPARTMENT: Operations, Pharmacy 2.0
REPORTING TO: Director, Customer Service

Serves as a liaison between Account Management and internal business partners in executing on strategic initiatives. Facilitates a wide range of complex operational activities. Perform on site implementation of new LOBs, deployment of new processes and conduct post implementation review. Advocate for vendor account management organization during various business owner meetings to ensure vendor processes are represented. Leads cross functional groups in setting the direction for future processes and infrastructure changes based on post-implementation reviews, etc.

Essential Functions:

  • Collects and documents business processes from internal teams to Apply analysis and independent judgment to internal business processes and the implementation of processes at vendor sites.
  • Gathers information and input from multiple sources to make decisions regarding the tools and processes needed for the vendor teams to execute on the strategic initiatives implemented by the Account Relations Managers (ARM)
  • Identifies how complex vendor tasks and special functions are aligned with internal business functions for accurate and compliant vendor processes.
  • Leads the implementation of new processes at vendor locations by working with Account Management team on implementations, changes to business practices and revamp of current strategic initiatives.
  • Chairs cross functional meetings between vendors, ARMS and internal business partners to assist in mitigating barriers to successful implementation
  • Acts as an empowered liaison between account management and internal business partners such as Operations Support Specialists (OSS), Quality Assurance (QA) in executing on strategic initiatives.
  • Communicates and reports project status via written and verbal reports to Account Managers, Vendors, and internal business partners.
  • Facilitates action log meetings with ARMs and OSS and coordinates meetings with business owners.
  • Develops processes for account management to achieve corporate deliverables, i.e. implementations, cost reductions, CMS and State Agency compliance requirements, new process requirements, etc.
  • Makes independent decision to ensure processes, tools and system access vendors provide compliant day to day operations that bring quality and value to the total enterprise.
  • Manages project volumes and tasks to meet critical deadlines.
  • Represents Account Management team in various work groups/committees as assigned.
  • Drives ongoing process improvement to deliver increasing vendor quality, compliance, and efficiency in all vendor related processes.
  • Drives the implementation of best practices for improved performance on CAHPS surveys and Customer Experience.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in Business, Finance or related field
  • Required Other 4 years experience handling escalated call center issues may substitute for degree
Candidate Experience:
  • Required 4 years of experience in Handling service issues in a call center environment
  • Required 1 year of experience in vendor management
  • Preferred 2 years of experience in overall managed care
  • Preferred Other Medicare/Medicaid health plan experience
  • Preferred medical claims (holds and payments)
Candidate Skills:
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Ability to influence internal and external constituents
  • Advanced Ability to work in a fast paced environment with changing priorities
  • Advanced Ability to effectively present information and respond to questions from peers and management
  • Advanced Ability to work independently
  • Advanced Ability to communicate and make recommendations to upper management
  • Intermediate Other Solid understanding of managed care, vendor provider agreements and the delegation process
  • Intermediate Other Proven background in call center operations to manage, implement and optimize services by vendors within customer service environment
  • Intermediate Other Ability to handle responsibilities that are complex with results that may have long-range implications
  • Intermediate Other Ability to remain calm under pressure
  • Intermediate Other Demonstrated aptitude and experience for managing processes across functional teams
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Word
  • Required Intermediate Healthcare Management Systems (Generic)
Languages:

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Last Updated On: 12/9/2015