Eligibility Analyst
Posted on: 12 Sep 2021
Tampa, FL
Job Description
Position Purpose:
Responsible for the enrollment and eligibility data loading and department analysis of those metrics. Efficiently and accurately entering and/or modifying eligibility data in a dental benefit system according to established requirements and procedures.
Run adhoc reports, graphs, and various data analysis
Identify, scope, prioritize, and present solutions to eligibility issues and implementations
Responsible for state regulatory files accompanied by research, and reconciliation
Conduct training on advanced systems, running reports and problem solving research
Resolve monthly discrepancy reports due to connector issues
Responsible daily discrepancies reports due to connector issues
Act as the go to person for vendor and business unit’s questions and issues
Serve as the local point person with the Regulatory Authority on enrollment/eligibility
Oversee management of eligibility imports
Education/Experience:
Bachelor’s degree in Computer Science, related field or equivalent experience. 1+ years of related data analysis and/or file conversion experience.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
