Skip to main content
The search value cannot be empty
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.
Return to Site
Need a Plan
Webcasts and Presentations
Request Press Kit
Corporate Functions & Operations
Corporate Functions & Operations Jobs
Claims Specialist Job
Full Job Title:
Claims Specialist II
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.
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.
Arizona representatives may provide provider phone coverage two days a week
Required A High School or GED
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
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:
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Back to top
and receive job alerts
Last Updated On: 12/9/2015