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Supv, Claims Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  0902532
Categories:  For-Profit Senior Services
Job Role:  Operations / Office Manager
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: We provide managed care services targeted exclusively to government-sponsored health care programs, focused on Medicaid and Medicare, including prescription drug plans and health plans for families, and the aged, blind and disabled. As of March 31, 2009, we served nearly 2.5 million members. Our experience and our exclusive commitment to these programs enable us to serve our members and providers, and to manage our operations efficiently.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the Company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national PDP provider and the largest Medicaid plan in Georgia. Today WellCare has grown to be the eighth largest publicly traded health care plan in the country with 3,800 associates and nearly 2.5 million members nationwide.
Position is responsible for overseeing the operations and functions of their Claims Units and for monitoring daily performances as it pertains to the production, quality, and service to ensure that company goals are met.

 


Essential Functions:



  • Develop and implement departmental policies and procedures.

  • Ensure that departmental standards and timelines are met within each unit.

  • Provide technical support to staff by answering questions and resolving technical issues.

  • Communicate and report departmental activities to the manager of Claims.

  • Communicate with other departments to provide information and resolve claims related issues.

  • Accept the responsibilities of the manager of Claims in his/her absence and ensure that the department runs smoothly & without disruption to the daily routine.

  • Monitors associate performance and conducts counseling/corrective action procedures when required

  • Provides significant input to performance evaluation, hiring and termination decisions for associates in work group

  • Reviews time records, sets schedules and approves all vacation/time off requests for subordinate associates

  • Conducts new associate training in area policies/procedures and workflow processes

  • Acts as subject matter expert for area of responsibility 

  • Makes recommendations for process improvement as needs are identified.

  • Serves as first line contact for the company's problem resolution procedure for associates in his/her work group.

  • Perform other duties as assigned. 

Education:  High school diploma or GED             

 

Experience:  2 years of directly relevant work experience

Minimum of five (5) years experience in claims management and/or managed care

 

Special Skills (e.g. 2nd language):  Thorough knowledge of managed healthcare to include claims processing, coding, medical terminology, service, authorizations and provider contracts.

 

Technical Skills/Requirements:  Oral and written communication skills sufficient to communicate clearly and grammatically to associates within the work group, to direct management or to customers.

Knowledge of email systems such as Microsoft Outlook sufficient to communicate with both internal and external contacts.

Knowledge of Word and/or Excel sufficient to enter data, copy or cut and paste data and print results as required. 
Post Date:  07/31/2010
 

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