Nov 13, 2019

Compliance Case Admin / Investigations Intake Specialist

  • Professional Diversity Network
  • Tampa, FL, USA
Full-Time Finance

Job Description

WellCare Health Plans

Reports To: Sr Mgr., Compliance Invest, Compliance-SIU & Corporate InvestigationDept.: ComplianceLocation: Henderson Road, Tampa, FL

Position enters data and other information into case and work management tracking system. Retrieves, analyzes, and compiles data and other information for various case matters. Assists in preparing reports and other documents to be submitted to regulatory and other governmental agencies and business partners. Conducts research of statutory, regulatory, and contractual requirements.

Essential Functions:

  • Retrieve, analyze, and compile data and other information necessary for health insurance industry regulatory reporting and in response to various information requests.
  • Handle Hotline call intake and initial response.
  • Prepare reports and other documents to be submitted to regulatory and other governmental agencies and business partners.
  • Enter into case and work management system information and data relating to complaints, cases, requests for information, and other incidents or matters.
  • Conduct research of statutory, regulatory, and contractual requirements.
  • Maintain organized files.
  • Develop knowledge of health care investigative activities.
  • Maintain confidentiality of all sensitive information.
  • Participate in meetings and training as required.
  • Monitor and report to management on the status of assigned projects, anticipating and identifying issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies.
  • Contribute to continuous improvement of work product and processes.
  • Advocate of the importance of compliance and the compliance program to health plan staff by promoting increased awareness of the Corporate Ethics and Compliance Program, understand new and existing compliance issues and related policies and procedures, and understand importance of internal compliance audits.
  • Develop and maintain productive relationships with all levels of management as well as regulators and other relevant external parties.
  • Perform special projects and other duties as assigned.
Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred An Associate's Degree in a related field
Candidate Experience:
  • Required 3 years of experience in a professional health care or health insurance setting
  • Required 1 year of experience in working in an office setting assisting with confidential matters (i.e. HIPAA)
  • Preferred 1 year of experience in customer service type role
  • Preferred 1 year of experience in working with confidential personnel documentation
  • Preferred Other previous experience working with governmental health care regulations
Candidate Skills:
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to multi-task
  • Intermediate Demonstrated organizational skills
  • Intermediate Demonstrated time management and priority setting skills
  • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Intermediate Demonstrated analytical skills
  • Intermediate Other Ability to understand and work with complex statutory, regulatory, and contractual requirements.
  • Intermediate Other Ability to understand and follow verbal instructions and written policies and procedures.
  • Advanced Demonstrated ability to deal with confidential information
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Other Ability to learn and work effectively with other business computing and operating systems and databases.
  • Preferred Intermediate Other Compliance 360

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 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.



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