Claims Support Representative

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🔥 2 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

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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

• Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files. • Review requests involving Power of Attorney, Guardianship and Authorizations to Release Information. • Assist the Claims team in requesting medical documentation to adequately adjudicate long-term care eligibility. • Reviewing the documents received to determine if complete and accurate. • Assist Claims Management with assigning work activities to associates within our workflow. • Respond professionally and timely to customer inquiries. • Ensure service calls are made in a timely, efficient and knowledgeable manner. • Follow up on any outstanding documentation with additional correspondence, reviewing fax failures, and reviewing any returned mail. • Contact providers and customers to obtain accurate contact information. • Maintain current knowledge of federal, state, and insurance regulations and requirements. • Maintain working knowledge of all company and services pertaining to business segment. • Maintain working knowledge and proficiency in company claims and administrative software systems as well as Microsoft applications. • Maintain client and company quality and production standards. • Maintain knowledge of applicable company policies and procedures. • Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information. • Other duties may be assigned

🎯 Requirements

• High School diploma required and previous experience in the Long-Term Care insurance industry and/or administrative preferred but not required. • Ability to read, analyze, and interpret complex documents. • Ability to respond effectively to the most sensitive inquiries or complaints. • Ability to write policies and procedures. • Ability to make effective presentations. • Excellent verbal and written communication skills. • Customer Service; Work Standards; Decision-Making; Communication; Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility. • Must have the ability to add, subtract, multiply, and divide in all units of measure. • Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. • Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. • Ability to deal with problems involving several concrete variables in standardized situations.

🏖️ Benefits

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • PTO Tier • Non-exempt