Claims - Process Lead, Claims

Wellcove/CHCS-Services • Pensacola, FL

3d

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.
The role of a Claims Process Lead involves overseeing the claims processing workflow, ensuring compliance with regulations, and driving continuous improvement initiatives. Key responsibilities include:
Managing Claims: Overseeing the adjudication and processing workflows for claims, ensuring accuracy and compliance.
Team Leadership: Leading a team of claims processors, providing guidance, performance feedback, and training.
Quality Assurance: Implementing and monitoring QA protocols to ensure high accuracy in claim payments.
Problem Solving: Identifying and resolving issues in the claims lifecycle, collaborating with IT and Codebook teams.
Policy Compliance: Ensuring all activities meet strict compliance standards and adhering to HIPAA and federal regulations.
Process Improvement: Driving transformation initiatives and process optimization, and leading governance committee meetings.
Customer Service: Providing excellent customer service and managing costs, timelines, quality, and delivery of claims.
This role requires a strategic thinker, strong leadership skills, and a commitment to continuous improvement in claims handling practices.
At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Requirements

• strategic thinker
• strong leadership skills
• commitment to continuous improvement in claims handling practices

Responsibilities

• Managing Claims: Overseeing the adjudication and processing workflows for claims, ensuring accuracy and compliance.
• Team Leadership: Leading a team of claims processors, providing guidance, performance feedback, and training.
• Quality Assurance: Implementing and monitoring QA protocols to ensure high accuracy in claim payments.
• Problem Solving: Identifying and resolving issues in the claims lifecycle, collaborating with IT and Codebook teams.
• Policy Compliance: Ensuring all activities meet strict compliance standards and adhering to HIPAA and federal regulations.
• Process Improvement: Driving transformation initiatives and process optimization, and leading governance committee meetings.
• Customer Service: Providing excellent customer service and managing costs, timelines, quality, and delivery of claims.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees