Claims - Associate

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.

Requirements

• Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claims processing
• Evaluate claims against established guidelines, contracts, and regulatory requirements
• Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios
• Analyze medical records, policy documents, and other relevant information to make informed claim decisions
• Demonstrate proficiency in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes, medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately assess claims
• Apply knowledge of healthcare benefits and payment policies
• Provide clear and concise explanations of claim decisions to relevant parties
• Identify trends and patterns in complex claims to contribute to process improvements
• Candidate should be able to correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan