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Corporate Functions & Operations WellCare - Claims Careers

Claims Specialist Job

Full Job Title: Claims Specialist I

Job Number: 1802329

Location: Phoenix, AZ

Date Posted: 3-30-2018

This position is for Care1st Health Plan, a WellCare Healthplans, Inc. company.

Department: AZ- Ops Claims -Medicaid

Reports to: Operations Supervisor

Location: E. Camelback Rd, Phoenix AZ 85016

Job Type: Hourly/ Non-exempt

Researches and processes institutional and/or professional 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.
  • Researches post payment claims issues and takes necessary action for correction.
  • Research claims issues and works with other departments to resolve claim issues.
  • Assists with special projects as assigned or directed.
Additional Responsibilities:
  • Arizona representatives may provide provider phone coverage two days a week
Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Preferred 1 year of experience in Previous claims or health insurance
Candidate Skills:
  • Beginner Ability to multi-task
  • Beginner Ability to work independently
  • Beginner Ability to communicate and make recommendations to upper management
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Beginner Demonstrated written communication skills
  • Beginner Demonstrated analytical skills
  • Beginner Demonstrated problem solving skills
  • Beginner Demonstrated time management and priority setting skills
  • Beginner Demonstrated organizational skills
  • Beginner Knowledge of healthcare delivery

Technical Skills:
  • Required Beginner Microsoft Outlook
  • Required Beginner Microsoft Word
  • Required Beginner Microsoft Excel

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Last Updated On: 12/9/2015