Claims - Examiner, Claims

Who We Are 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. Duties/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 rega