Claims - Claims Examiner

Wellcove CHCS Services
Pensacola, FL
Category Insurance
Remote
Job Description
Wellcove is seeking a Claims - Claims Examiner to manage and handle all Outbound calls and adjudicate claims. The ideal candidate will have experience in handling US HIP claims, knowledge of medical terminology, human anatomy, and basic math knowledge.

Requirements

  • Adjudicating HP/AD claims
  • Handling all Outbound calls
  • Prioritizing work and adjudicating claims as per turnaround time
  • 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
  • Responding to and resolving claims received via emails
  • Calculating claim amounts for customers
  • Complying with company regulations regarding HIPAA, confidentiality, and private health information
]]>