Claims - Support Representative, Claims

Wellcove/CHCS-Services•Pensacola, FL

1d•Onsite

About The Position

This position is responsible for the administrative support duties of most levels of claims in accordance with policy, company, state, and federal guidelines. This position is for Long Term Care Insurance Plans administered by Prudential.

Requirements

Advance product knowledge, comprehensive understanding of insurance terminology and definitions, core knowledge of company and department processes and procedures related to the ability to complete job responsibilities /duties in a proficient and professional manner.
Ability to read, analyze, and interpret complex documents; ability to respond effectively to the most sensitive inquiries or complaints; ability to write policies and procedures; ability to make effective presentations; ability to exhibit excellent verbal and written communication skills
Customer Service; Work Standards; Decision-Making; Communication; Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility
Must have the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals; Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form; Ability to deal with problems involving several concrete variables in standardized situations.

Nice To Haves

Previous experience in the Long-Term Care insurance industry and/or administrative preferred but not required.

Responsibilities

Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files.
Review requests involving Power of Attorney, Guardianship and Authorizations to Release Information.
Assist the Claims team in requesting medical documentation to adequately adjudicate long-term care eligibility. Reviewing the documents received to determine if complete and accurate.
Assist Claims Management with assigning work activities to associates within our workflow.
Respond professionally and timely to customer inquiries.
Ensure service calls are made in a timely, efficient and knowledgeable manner.
Follow up on any outstanding documentation with additional correspondence, reviewing fax failures, and reviewing any returned mail.
Contact providers and customers to obtain accurate contact information.
Maintain current knowledge of federal, state, and insurance regulations and requirements.
Maintain working knowledge of all company and services pertaining to business segment.
Maintain working knowledge and proficiency in company claims and administrative software systems as well as Microsoft applications.
Maintain client and company quality and production standards.
Maintain knowledge of applicable company policies and procedures
Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information.
Other duties may be assigned