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Corporate Functions & Operations WellCare - Operations Support Careers

Data Reconciliation Specialist Job

Full Job Title: Data Reconciliation Specialist

Job Number: 1703936

Location: Tampa, FL

Date Posted: 8-28-2017

Department: Operations

Reports to: Operations Supervisor

Location: 5301 Idlewild Ave Tampa FL 33634

Responsible for accurately researching and responding to Provider Check Tracer, Returned Check, OTC Member Reimbursement and Medical Member Reimbursement inquiries for all lines of business.

Essential Functions:
  • Research the provider/member reimbursement inquiry to determine if replacement payment/reimbursement is warranted.
  • Ensure vendor and member address data is accurately reflected in our system.
  • Identify root cause of each inquiry and partner with appropriate party (provider, member, configuration, market etc.) to ensure issue resolution for all work types.
  • Process OTC Member Reimbursement requests timely and accurately.
  • Submit manual check requests to Accounts Payable.
  • Actively track and follow up on all assigned inquiries using all available tools and resources.
  • Maintain department standards for production, accuracy and quality.
  • Assists with other projects and duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 1 year of experience in Claims processing or general healthcare background. Internal candidates must also meet key performance metrics.
  • Preferred 1 year of experience in Billing, Banking, Accounting, Pharmacy and/or Appeals background
Candidate Skills:
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Ability to work in a matrixed environment
  • Intermediate Ability to work independently
  • Intermediate Ability to work as part of a team
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Other data entry skills

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Last Updated On: 12/9/2015