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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration Data Specialist Job

Full Job Title: Configuration Data Specialist*

Job Number: 1805191

Location: Phoenix, AZ

Date Posted: 2018-07-23

To ensure accurate and timely loading and maintenance of provider file information through appropriate research. This would include, but not be limited to: initial loads based on claim receipts, provider demographics, vendor information, terminations, and researching, analyzing and making appropriate adjustments to the daily departmental reports.

DEPARTMENT: Provider Relations

REPORTS TO: Director of Network Management

Essential Functions:

  • Performs accurate and timely provider research, verification and analysis. Including verification of license status utilizing designated web pages when new providers are added to the system.
  • Performs research to respond to inquiries and interprets policy provisions to determine most effective response.
  • Resolves provider load issues within established documented processes.
  • Ensures the proper supporting documentation exists and is maintained on file for all load processes.
  • Loads and maintains provider data.
  • Responds to inquiries from provider field staff,
  • Resolves critical errors forwarded from the claims department.
  • Updates tracking database.
  • Responsible for building and maintaining positive business relationships with business partners.
  • Assists in special projects.
  • Maintains high quality work.
  • Meets productivity expectations.
  • Works Auto Analyzer Reports.
  • Performs other duties as assigned
  • Completes assignments thoroughly, accurately and on time.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 1 year of experience in health insurance
    Candidate Skills:
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated analytical skills
    • Intermediate Demonstrated problem solving skills
    • Intermediate Demonstrated time management and priority setting skills
    • Intermediate Other Knowledge of Claims Processing
    • Intermediate Other Basic understanding of provider types and specialties
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Preferred Intermediate Other Knowledge of CPT/HCPCS coding
      • Preferred Intermediate Other Knowledge of provider billing practices
      Languages:

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        Last Updated On: 12/9/2015