Claims - Claims Examiner
About The Position
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.
Requirements
- Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
Responsibilities
- Manage and handle all Outbound calls and adjudicate claims.
- 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
- 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
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
