This link will leave wellcare.com, opening in a new window. WellCare and its subsidiaries are not responsible for non-WellCare content, privacy practices, products or services described on these websites.
The ideal candidate will have a claims background of at least 2 years and can translate claims process impacts/changes into tasks, to drive business implementations. Serves also as a department SME for a wide range of tasks and special functions to include vendor support, training, quality reviews, new business implementations, reporting analytics, process improvement, etc.
Exhibits a high level of professionalism and can interact with various levels of the organization including Sr. Leaders.
Serves as liaison between department and business partners, both internal and external.
Plan, manage, monitor, perform UAT and complete key improvement projects in an accurate and timely manner.
Identifies, evaluates, recommends and implements data-driven process improvement initiatives.
Provide support on tasks and special functions such as vendor oversight, contracting, inventory monitoring, reporting, new business implementations, quality reviews, root cause analysis, training, operational processes, etc.
Maintains/ Creates resources applicable to assigned area, such as timely updates to training, announcements, step actions, reference call tools, FAQs etc.
Represents team in cross functional environment and collaborates with leadership to implement new processes.
Partners with WellCare vendors supporting operations. Supports and assists all LOB's with specific focus on Health Services, Pharmacy, Medicaid, Exchanges, Medicare and PDP, etc.
Investigates problems of a moderately complex nature and provide findings, impact, remediation and preventative actions in a clear and concise manner.
Analyzes data and reports to identify trends, operational issues, financial impact of implemented initiatives, etc. May need to run existing SQL queries to generate data into Excel to conduct research and analysis.
Other duties as assigned.
Required A High School or GED
Preferred A Bachelor's Degree in a related field
Required 3 years of experience in a related field based on assigned area
Preferred Other Previous experience in a customer service environment and health insurance
Demonstrated analytical skills
Demonstrated written communication skills
Demonstrated interpersonal/verbal communication skills
Ability to communicate and make recommendations to upper management
Strong understanding of managed care and its place in the health care industry
Understanding of interdependencies on other business units such as Health Services, Provider Relations, Sales, Vendors, Claims
Demonstrate ability to implement process improvements