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Corporate Functions & Operations WellCare - Operations Support Careers

Claims Operations Support Specialist Job

Full Job Title: *Claims Operations Support Specialist

Job Number: 1803738

Location: Tampa, FL

Date Posted: 5-25-2018

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.

Essential Functions:
  • 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.
Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred A Bachelor's Degree in a related field

Candidate Experience:

  • 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

Candidate Skills:

  • 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

Technical Skills:

  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Preferred Intermediate Microsoft PowerPoint
  • Preferred Intermediate Microsoft Visio
  • Preferred Intermediate Xcelys

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Last Updated On: 12/9/2015