Third-Party Administration for the World's Leading Brands
Claims Support Representative
Location
Florida
Posted
5 days ago
Salary
0
Seniority
Senior
Job Description
Claims Support Representative
Wellcove
• 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
Job 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
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