Grievance Coordinator
WellCare - Tampa, FL

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1204175

About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. For more information about WellCare, please visit the Company's website at www.wellcare.com.

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 prescription drug plan provider and the largest Medicaid plan in Georgia. WellCare expanded its services when it began offering Medicaid managed care plans in Ohio and Missouri in 2007, and Medicare managed care plans in Texas and New Jersey in 2008. Additional growth followed when the company was chosen to serve Hawaii's Medicaid program for the aged, blind or disabled in 2009, and in 2011 when it was selected to serve Kentucky's Medicaid program. Today, WellCare has more than 3,900 associates and approximately 2.4 million members nationwide.

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.

Description

Responds to member and provider inquiries (phone, written or walk in) regarding all aspects of WellCare business, including claims, in a professional, timely, accurate and caring manner while consistently meeting all guidelines.

Essential Functions:
Responds to member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.

Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.

Records, investigates and resolves member complaints as detailed in the Grievance Procedure narrative.

Assists in the education of new members and in the re-education of existing members regarding health plan procedures.

Track grievance case by line of business for compliance and review.

Assist in resolving member and provider complaints

Makes decisions that are consistent with the concept of a win-win-win for members, associates and WellCare.

Demonstrates based behaviors such as initiative, accountability and value.

Performs skills necessary to create a high-quality customer experience, as reflected through acceptable quality audit score and productivity.

Qualifications

Education:
High School Diploma required, associates degree preferred

Experience:
1-3 years experience within a call center or customer service environment

1 year Grievance experience preferred

Experience within a health care company preferred

Licenses/Certifications:
Customer service, quality or training certifications (preferred)

Special Skills (e.g. 2

nd

language):
Strong written and verbal communication skills and an ability to work with people from diverse backgrounds

Ability to multi-task, good organizational and time management skills

Ability to act on feedback provided by showing ownership of his or her own development

Ability to read, analyzes, and interprets verbal and written instructions

Ability to write business correspondence

Ability to effectively present information and respond to questions from members

Ability to define problems collects data, establish facts and draw valid conclusions

Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication

Technical Skills/Requirements:
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

Primary Location

FL-Tampa

Is a relocation package available?

No

WellCare - 22 months ago - save job - copy to clipboard
About this company
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WellCare knows that to get well, all you need is a little care. WellCare Health Plans provides managed-care administrative services to...