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Corporate Functions & Operations WellCare - Claims Careers

Claims Customer Service Job

Full Job Title: Claims Customer Service Representative

Job Number: 1802255

Location: Phoenix, AZ

Date Posted: 4-3-2018

Answers incoming provider calls regarding claim status. Provides excellent customer service including a positive attitude, the ability to identify root cause issues and education and resolution to provider inquires in a timely and accurate manner. Ensures all calls received are properly inputted into the phone tracking system and follow-up is performed to fully resolve claim issues. Provides feedback regarding trends and training needs within the Claims Department to improve accuracy of claims processing and processing claims and/or assisting with reports in between calls.

Essential Functions:
  • Answers all incoming provider calls in a timely, efficient and knowledgeable manner.
  • Provides excellent customer service to external and internal customers.
  • Reviews provider claim requests for appropriate information and accurate reimbursement.
  • Accurately routes claims requiring adjustments for correction.
  • Researches and follows up on claim adjustment requests to ensure first call resolution.
  • Accurately adjudicates claims in accordance with health plan guidelines, company standards, and company procedures in between calls.
  • Properly documents all incoming calls to the phone tracking system.
  • Reviews history of claim in question, researches particulars and contacts appropriate personnel to verify information.
  • Identifies trends and processing issues related to the rework of claims.
  • Prioritizes and manages individual workflow as need.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 2 years of experience in customer service
  • Preferred 2 years of experience in claims processing (Medicaid and Medicare a plus)
Candidate Skills:
  • Intermediate Ability to multi-task
  • Intermediate Ability to work as part of a team
  • Intermediate Demonstrated customer service skills
  • Beginner Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Beginner Demonstrated organizational skills
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Beginner Knowledge of healthcare delivery
  • Intermediate Other Demonstrated follow up skills
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Beginner Microsoft Word
  • Required Beginner Microsoft Outlook
  • Required Beginner Microsoft Excel
  • Required English

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Last Updated On: 12/9/2015