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Claims Specialist

Expired Job

Wellcare Health Plans Inc. Phoenix , AZ 85002

Posted 2 months ago

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.

Essential Functions:

  • 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.

Additional Responsibilities:

  • Arizona representatives may provide provider phone coverage two days a week

Candidate Education:

  • Required A High School or GED

Candidate Experience:

  • 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

Candidate Skills:

  • 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:

Technical Skills:

  • Required Intermediate Microsoft Outlook

  • Required Intermediate Microsoft Word

  • Required Intermediate Microsoft Excel

Languages:


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Claims Specialist

Expired Job

Wellcare Health Plans Inc.