Claims Associate

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Wellcove

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1989

🛡️ Insurance

🏥 Healthcare

☁️ SaaS

Insurance • Healthcare • SaaS

Wellcove is a third‑party administrator (TPA) focused on the senior market and long‑term care (LTC) benefits. Its cloud‑native LTC Now platform and AssuriCare services provide automated claim administration, eligibility determination, auto‑adjudication, payment processing, digital care management, provider matching, risk evaluation/analytics, and business process outsourcing for carriers, state retirement plans, and reinsurers. The company emphasizes automation, payment integrity, and tailored administrative solutions for long‑term care and Medicare supplement administration.

📋 Description

• 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.

🎯 Requirements

• Medical Graduates – MBBS, Physiotherapists, B-Pharma or life science graduates with minimum 1 year of experience in handling US Health Insurance claims. • Graduates and Fresher. • Should have strong English comprehension, verbal and written skills • Strong medical science knowledge to comprehend medical reports • Should have basic math knowledge of calculating simple interest, compound interest. • Should have good English comprehension and analytical skills • Should have excellent problem-solving skills with an eye for detail