Claims - Claims Examiner

Who We Are

Wellcove has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.

Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.

As a Third-Party Administrator, CHCS Services Inc. manages eight (8) Health and Life, lines of business in the Claim Department; Medicare Supplement/Select; Hospital/Indemnity; Cancer/Critical Illness; Major Medical; Life/Annuities; Long Term Care; Dental; Disability. 

This position is responsible for the review and adjudication of most levels of claims in accordance with policy, company, state, and federal guidelines for Medicare Supplement Insurance.

Supervisory Responsibilities:

This job has no supervisory responsibilities.

 Duties/Responsibilities:

• Responsible for accurate/timely daily review of Long-Term Care claims and policy provisions to process payment or issue denial.  This role does not involve full claim handling from claim receipt or intake to closure.  In terms of claims handling, this position is specifically limited to the payment or adjudication of invoices pertaining to long term care claims.
• Responsible for the identification, analysis and application of long-term care claim product features including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits. 
  Meet or exceed minimum production and quality targets as approved by management.   
• Respond accurately, timely and professionally to all oral and written external and/or internal correspondences received from stakeholders in regard to benefits, eligibility, claim payments, denials and/or explanation of benefits. As well as inbound claim calls.
• Maintain working knowledge of all company services pertaining to business segment, company claims, administrative and imaging software systems such as INSPRO and Microsoft applications 
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines. 
• Other duties as assigned.

At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.