At WellCare, we are a passionate team with a strong mission and a focused purpose: to serve our members and communities in which they live while helping them live better, healthier lives. Our culture is one of empowerment, teamwork and commitment as we all work together to deliver cost-effective solutions that create positive outcomes for our members. Join us a career that inspires passion and purpose across all levels and disciplines within our award-winning organization.

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.

Department: Ops-Claims I

Reports to: Supv. Claims

Location: Tampa, FL

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

Languages:About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a “World’s Most Admired Company” in 2018 by Fortune magazine. For more information about WellCare, please visit the company’s website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.