Claims - Claims Examiner

Wellcove/CHCS-Services • Pensacola, FL

10d • Remote

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

Requirements

• should have knowledge of medical terminology, human anatomy with basic math knowledge of calculating simple interest, compound interest.
• Should have excellent problem-solving skills with an eye for detail, to be able to do root cause analysis of complex claims
• Should have a positive approach and open to learning process dynamics
• Ready to handle work pressure and ensure deliverables within timelines
• Experience in handling US HIP claims
• Should have knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
• Should have some experience in reading and comprehending medical documents
• Collaborative team spirit.
• Accountable and able to work remotely and independently.
• Able to pass background screening and drug tests pre and post hire – includes THC
• Verification of high school, GED, or college diploma upon request.
• Timely responses from three professional references.
• Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
• Able to provide an ongoing reliable internet connection and access to a smart phone for Multi Factor Authentication and communication purposes.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED