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Corporate Functions & Operations WellCare - Claims Careers

Claims Specialist Job

Full Job Title: Claims Specialist II

Job Number: 1702646

Location: Phoenix, AZ

Date Posted: 7-13-2017

Researches and processes institutional and professional claims. Serves as a mentor to less experienced associates and acts as a resource to resolve more complex claims.

Essential Functions:

  • Processes claims that pend for various hold reasons to assist in the final determination on claim disposition.
  • Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs.
  • Researches complex claims issues and works with all external departments, markets, and providers on claims related content.
  • Completes new hire audits.
  • Runs and analyzes ad-hoc reports.
  • Identify root-cause issues to ensure enterprise solutions and communicate findings as needed.
  • Participates in all formal and informal training opportunities.
  • Assists with special projects as assigned or directed.
Additional Responsibilities:
  • Arizona representatives may provide provider phone coverage two days a week
  • Please note that the opportunity to telecommute will determined in approximately 90-days from hire date.
Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 2 years of experience in Previous claims or health insurance (for external candidates)
  • Required 6 months of experience in Institutional and / or professional claims
Candidate Skills:
  • Intermediate Ability to communicate and make recommendations to upper management
  • Intermediate Ability to multi-task
  • Intermediate Ability to work independently
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated analytical skills
  • Intermediate Demonstrated customer service skills
  • Intermediate Demonstrated organizational skills
  • Intermediate Demonstrated time management and priority setting skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated problem solving skills
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
Languages:

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Last Updated On: 12/9/2015