Department: Operations - Payment Integrity
Reports to: Operations Supervisor
Location: 7840 Woodland Corporation Blvd. Tampa FL 33614
Initiates contact to other insurance companies to gather coordination of benefits (COB) data. Consolidates the activities that support the collection, management and reporting of other insurance coverage. Additionally, provides outreach screening services for WellCare Medicare members who are potentially eligible for benefits through the Medicare Savings Program (MSP). Provides necessary telephone support for various Medicaid and Medicare programs.
Additional Responsibilities:Candidate Education:
- Responsible for investigating and validating potential Third Party Liability (TPL) / Coordination of Benefits (COB) instances for WellCare membership.
- Validates primary insurance coverage for claims received by WellCare with attached EOBs.
- Maintains accurate member COB information within Xcelys and COB application.
- Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
- Performs skills necessary to create a high-quality stakeholder experience, as reflected through acceptable quality audit score and productivity.
- Conducts outreach phone calls and initial MSP eligibility screenings to potentially eligible members, Deeming members, and their families.
- Prepares information packets and Medicaid applications to mail to MSP eligible members.
- Submits Medicaid applications to state-agencies on behalf of members, when requested by member.
- Answers incoming calls from members, Customer Service, Case Managers and Benefits Consultants and provides information related to Medicare Savings Program, Extra Help Program, Medicaid status, Medicaid eligibility screening, and D-SNP Deeming status.
- Tracks status of MSP applications and approvals for accurate reporting to Finance, Special Populations, Case Management and Product/Sales teams.
- Answers incoming phone calls from Pre-Enrollment, Benefit Consultants or 1099 staff for Medicaid Verification.
- Provides Medicaid, Medicare and Low Income Subsidy (LIS) eligibility details to inbound caller and documents in SalesForce.
- Verifies Medicaid eligibility for any paper applications received by WellCare.
- Assists in the validation of continued DSNP eligibility for all current DSNP membership.
- Performs special projects, as requested by management.
- Required A High School or GED
- Preferred An Associate's Degree in a related field
- Required 1 year of experience in a call center or customer service environment
- Preferred Other Experience within a health care company
Licenses and Certifications:
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to multi-task Ability to multi-task, good organizational and time management skills
- Intermediate Demonstrated organizational skills
- Intermediate Demonstrated time management and priority setting skills
- Intermediate Ability to effectively present information and respond to questions from peers and management Ability to effectively present information and respond to questions from management or other internal associates
- Intermediate Ability to effectively present information and respond to questions from families, members, and providers
- Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Ability to define problems collects data, establish facts and draw valid conclusions
- Advanced Demonstrated customer service skills Demonstrates appropriate customer-care skills
- Intermediate Other Ability to act on feedback provided by showing ownership of his or her own development
- Intermediate Other Ability to read, analyze, and interpret verbal and written instructions
- Intermediate Other Ability to write business correspondence
- Intermediate Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
- Intermediate Other Ability to work with people from diverse backgrounds
- Intermediate Other Perform skills necessary to create a high-quality stakeholder experience, as reflected through acceptable quality audit score and productivity
- Intermediate Other Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
A license in one of the following is required:
- Preferred Other Customer service, quality or training certifications
- Required Beginner Microsoft Outlook Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts
- Required Beginner Microsoft Word Knowledge of Word and/or Excel sufficient to enter data
- Required Beginner Microsoft Excel