Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

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


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Specialist 2

State Of Arizona

Posted 1 week ago

VIEW JOBS 11/4/2018 12:00:00 AM 2019-02-02T00:00 DEPARTMENT OF ECONOMIC SECURITY Providing Opportunity, Assistance and Care for Arizonans in need! ARIZONA MANAGEMENT SYSTEM (AMS): All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. CLAIMS SPECIALIST 2 Division of Employment & Rehabilitation Services 1789 W. Jefferson Phoenix, AZ 85007 This posting will remain open until a sufficient amount of resumes are received. JOB SUMMARY: The Child Care Administration is seeking a skilled and analytical individual who will utilize accounting principles and practices with GAO Accounting and DES Accounting and CCA Budget office to support the Payment Processing Unit. This position is responsible for the review, processing, resolution, and research of child care claim information for the statewide Payment Processing Unit for the Child Care Administration. The Claims Specialist 2 will act as a Lead Specialist by assisting in training of staff on proper processes and developing training on policies and procedures to providers. JOB DUTIES: * Responsible for monthly review, analysis, validate and adjudication of over 7000 child care claims from certified homes and centers/providers for payrolls that exceed $15 million per month. * Responsible for daily preparation and verification of payroll reports and statements to ensure a match for warrant numbers and funding streams, prior to release to accounts payable. * Work with both State and Federal auditors as well as with independent auditors in conducting research into payments made based on contract with providers. * Evaluate financial and narrative reports on overpayments in an attempt to collect money from providers. * Conduct income verification for contracted providers with financial institutions that require income information before determining that the provider is eligible for a loan, also with City, County and State administered programs or other services. * Responsible for initiating replacement warrant process when a child care provider claims that a warrant has been lost. Identify repetitious or suspicious claims of a lost warrant and initiate OSI inquiry. * Troubleshoot in resolving payment issues, Identify claims which may conflict with child care rules, regulations, policies or procedures and refer to specialist, Supervisor and Contracts Manager for review. * Assist providers, either in person or over the phone, by resolving situation or referring to appropriate individual or agency. KNOWLEDGE, SKILLS AND ABILITIES (KSAs): * Understanding of DES Child Care Policy and Procedures, and Federal and State laws on child care programs and funding sources * Knowledge of governmental financial management practices in order to prepare, modify, analyze or interpret billing claims presented for payment * Skilled in mathematics, computing and reconciliation, operating keyboard and operating ten-key calculator * Working knowledge of AZCCATS automated computer system and relationship of system modules to the authorization and subsequent payment of claims * Knowledge of overall subsidized child care payment system and related forms required to generate payment * Techniques of data processing as it relates to accounting practices, business and accounting procedures and financial reconciliation methods * and procedures * Exceptional oral and written communication * Skilled at research, evaluation, analysis, interpretation, and accounting principles * Experienced at comparing multiple documents comprised of authorization information and billing information, validating billing documents * Skilled in identifying problem claims and resolutions PREFERRED QUALIFICATION(S): * The ideal candidate will have data entry and accounting experience as it relates to financial reconciliation and procedures * The incumbent in this position will be responsible for high volume customer support over the phone. High percentage of clients are Spanish speaking. Bilingual candidates are encouraged to apply! PRE-EMPLOYMENT REQUIREMENTS: * Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired state employees * Successfully pass background and reference checks; employment is contingent upon completion of the above mentioned process and the agency's ability to reasonably accommodate any restrictions BENEFITS: The Department of Economic Security offers a comprehensive benefits package to include: * Sick leave * Vacation with 10 paid holidays per year * Health and dental insurance * Retirement plan * Life insurance and long-term disability insurance * Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance RETIREMENT: Positions in this classification participate in the Arizona State Retirement System (ASRS). Please note, enrollment eligibility will become effective after 27 weeks of employment. CONTACT US: If you have any questions please feel free to contact 602-542-3807 for assistance. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-364-3981. Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer. State Of Arizona Phoenix AZ

Claims Specialist

Expired Job

Wellcare Health Plans Inc.