Wellcove
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.
Claims Examiner
Job not on LinkedIn
🔥 13 minutes ago
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Wellcove
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
• Manage and handle all outbound calls • Adjudicate HP/AD claims • Prioritize work and adjudicate claims according to turnaround times • Research, review, summarize, and recommend courses of action on claims • Ensure claims are adjudicated according to client/company guidelines • Provide continual evaluation of processes and procedures • Respond to and resolve claims received via email
🎯 Requirements
• Strong English comprehension • Mathematics knowledge • Medical science knowledge to comprehend medical reports • Ability to prioritize work and adjudicate claims according to turnaround times • Ability to work independently on researching, reviewing, summarizing, and recommending courses of action on claims • Ability to calculate claim amounts correctly for customers • Compliance with company regulations regarding HIPAA, confidentiality, and private health information
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