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Corporate Functions & Operations WellCare - Data Analyst Careers

Configuration - Supervisor Job

Full Job Title: Supv, Configuration

Job Number: 1803946

Location: Tampa, FL

Date Posted: 6-1-2018

Position provides direct management of exempt and non-exempt associates responsible for accurate and timely maintenance of provider network, related automated pricing methodologies, daily workflow of team, and configuration liaison between the Market and Shared Services.

Essential Functions:
  • Oversees systematic processing of provider files sent from external vendors as well as those created internally through Batch processes.
  • Maintains technical understanding of price rules, fee schedules, and provider contract loads, assures staff is trained and up to date on these.
  • Manages and monitors key performance metrics and implements improvement plans either with an individual or at an aggregate level.
  • Handles all direct employee personnel issues and processes (where applicable), including performance management, appraisal processes, development planning, and career pathing.
  • Performs root cause analysis on global issues that affect downstream processes, including automated claims payments and Provider Directories.
  • Supervises direct reports by assigning workload, monitoring quality and associate coaching.
  • Serves as liaison between departments when it becomes necessary due to member or workflow issues.
  • Develops, recommends, and implements process improvements to improve efficiencies and services provided.
  • Oversees training associates on new processes and refresher training.
  • Facilitate and participate in meetings with other departments and line of business as needed.
  • Act in a liaison capacity for the Mgr/ Sr Mgr representing operations with other areas and business units.
  • Demonstrates desired behaviors by exceeding others expectations and leads by example
  • Completes gap analysis on training for the business.
  • 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 4 years of experience in Provider Network Development, Fee Schedules, High Volume Automated Claims Processes
  • Required Other Experience leading others on complex automated projects
Candidate Skills:
  • Intermediate Demonstrated analytical skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to communicate and make recommendations to upper management
  • Intermediate Other Technical understanding of automated claims processing, fee schedules, provider network structures, provider reimbursement methodologies. Understanding of contract terms and how they are loaded into the system.
  • Intermediate Other In-Depth knowledge of Health Insurance
  • Intermediate Other Strong understanding of managed care and its place in the health care industry
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Other Proficiency with all WellCare based systems utilized in job functions.
Languages:

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Last Updated On: 12/9/2015