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Retention Specialist (Greenville) - Wellcare Health Plans

Company: Wellcare Health Plans
Location: Greenville
Posted on: September 15, 2019

Job Description:

Works with sales management and corporate offices to identify real time abrasion/disenrollment potentials. Identifies areas of process breakdown and potential disenrollment to help build provider and member retention strategies based on detailed data analysis on Claims, Customer/Provider Service and Enrollment. Maintains a database of member problems and performs root cause analysis to suggest operational improvements to prevent similar issues from recurring. Functions as member advocate while still respecting sound business and health management practices.Reports to: VP, Field Sales and MarketingDepartment: SC-Sales-M'Caid-StatePosition Location: Greenville, SCEssential Functions:Works with members to amicably resolve issues and problems in a way that encourages those members to remain loyal to WellCare.Works with providers to correct billing and claims issues and educates providers about how to eliminate those problems going forward.Analyzes reports such as claims denial and front-end reject reason codes to determine appropriateness and areas of intervention.Determines specifications for ad-hoc reports needed for key abrasion/retention efforts and summarizes accordingly.Analyzes daily call contact reports to determine accuracy, follow-up, timeframes and possible disenrollment threats.Contacts members at risk for disenrollment based on report analysis and act as an elevated resolution team.Identifies additional areas of clarification needed for members and providers based on call contact reports and claims reporting.Monitors, analyzes and reports information from outsource vendors for disenrollment survey information.Communicates weekly with sales management regarding key areas of member and provider abrasion for tracking and trending.Analyzes grievance report data to determine trends and training needs and adherence to state reporting guidelines.Works with sales management on the maintenance of Sharepoint communication documents, banner messages, automatic email updates, and compliance alerts.Performs other duties as assigned. Additional Responsibilities:Candidate Education:Required An Associate's Degree in a related fieldPreferred A Bachelor's Degree in a related field Candidate Experience:Required 3 years of experience in claims processing, customer service, reimbursement methodologies and/or member retentionPreferred 1 year of experience in data, financial and reporting collection and analysisPreferred Other managed care or government program experience Candidate Skills:Beginner Demonstrated analytical skillsIntermediate Ability to effectively present information and respond to questions from families, members, and providersIntermediate Ability to effectively present information and respond to questions from peers and managementIntermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusionsIntermediate Ability to proof large bodies of materialsIntermediate Demonstrated organizational skillsBeginner Demonstrated project management skillsIntermediate Demonstrated interpersonal/verbal communication skillsBeginner Demonstrated written communication skillsIntermediate Ability to multi-taskIntermediate Demonstrated customer service skillsIntermediate Knowledge of healthcare delivery Licenses and Certifications:A license in one of the following is required:Preferred Licensed 2-40 Health Insurance Technical Skills:Required Beginner Microsoft ProjectRequired Beginner Microsoft AccessRequired Intermediate Microsoft WordRequired Intermediate Microsoft OutlookRequired Intermediate Microsoft PowerPointRequired Intermediate Microsoft ExcelRequired Intermediate Other Familiarity with reporting tools (Crystal, Discovery, etc.)Preferred Intermediate Other Experience with HSD Diamond managed care system Languages:About usHeadquartered 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.

Keywords: Wellcare Health Plans, Greenville , Retention Specialist (Greenville) - Wellcare Health Plans, Healthcare , Greenville, South Carolina

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