Claims Examiner

Job not on LinkedIn

🔥 6 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Review and adjudicate long-term care claims and policy provisions for payment or denial • Process payment or issue denial for invoices pertaining to long-term care claims • Identify, analyze, and apply long-term care claim product features and applicable policy benefits • Meet or exceed management-approved production and quality targets • Respond accurately, timely, and professionally to external and internal correspondence regarding benefits, eligibility, claim payments, denials, and explanations of benefits • Handle inbound claim calls • Maintain working knowledge of company services and claims, administrative, and imaging software systems • Operate in compliance with HIPAA, fraud, confidentiality, and private health information guidelines • Perform other duties as assigned

🎯 Requirements

• Working knowledge of company services pertaining to the business segment • Familiarity with company claims, administrative, and imaging software systems such as INSPRO and Microsoft applications • Ability to operate within HIPAA, fraud, confidentiality, and private health information guidelines • Ability to accurately and timely review long-term care claims and policy provisions • Knowledge of long-term care claim product features, including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits