Social Service Specialist

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation’s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children’s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve over 2 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company’s website at www.wellcare.com.

 

We are looking to add a Social Service Specialist to our team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be a part of a dynamic, growing organization, then this may be the opportunity for you.

 

Job Summary:

The Social Service Specialist contacts, explains and facilitates SSI/SSDI application activities for interested and potentially eligible Medicaid members.  This includes but is not limited to, evaluating, correlating and substantiating medical and comprehensive work histories through medical records, interviews and other documentation, acting as a member’s designated representative to Social Services, and coordinating additional treatment and/or specific evaluation with member’s physician to further substantiate disability.

 

Essential Functions:Interprets a variety of instructions furnished in written and oral formApplies regulatory requirements and accreditation standards to all review activity and reporting Applies accepted criteria to review process and utilizes the parameters.Ensure quality customer service and maintain confidentialityCollects information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation  Inputs review data into systemsRetrieves and distributes faxes Prepares and submit projects, reports or assignments as needed to meet department initiatives and/or objectives

 

Knowledge, Skills, Abilities Required:Assist in evaluating process improvements Demonstrate knowledge of medical terminology, CPT and ICD9 codingWork independently, handle multiple assignments and prioritize workload 

 

Education/Experience: Bachelor’s degree with major in counseling, social work, psychology, nursing, rehabilitation, criminal justice or other human services related field  Minimum of three years relevant case work with government agency preferred  Managed care experience preferred

 

Communication and Numeric Skills:Delivers verbal and written communications that are clear, concise, complete, and demonstrate professionalism and diplomacyOral communication skills sufficient to answer clearly a variety of questions from people both within and outside of the organizationOral communication skills sufficient to convey simple messages to co-workers and others within the organizationWritten communication skills sufficient to communicate clearly and grammatically both complex and simple messages to a wide audience either within or outside of the organizationPresent professional and positive image to customers and co-workers

 

Computer Skills:Knowledge of email systems such a Microsoft Outlook sufficient to communicate with both internal and external contactsKnowledge of Word sufficient to create simple documents such as memos and reportsKnowledge of Sidewinder and Diamond system sufficient to perform review and data entry preferred