Claims - Examiner, Claims

Who We Are Wellcove has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.

Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.

Job Summary Manage and handle all Outbound calls and adjudicate claims.

Duties/Responsibilities:

• Adjudicating HP/AD claims

• Handling all Outbound calls

• Should be able to prioritize work and adjudicate claims as per turnaround time

• Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment

• Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports

• To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures.

• To respond to and resolves claims received via emails.

• Candidate should be able to correctly calculate claim amounts for the customers

• Complying with company regulations regarding HIPAA, confidentiality, and private health information

Standard Company Requirements:

• Collaborative team spirit.