Claims - Claims Examiner

Manage and handle all Outbound calls and adjudicate claims.

 Duties/Responsibilities:

• Adjudicating HP/AD claims
• Handling all Outbound calls
• Should be able to prioritize work and adjudicate claims as per turnaround time
• Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims 
• Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
• To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures. 
• To respond to and resolves claims received via emails.  
• Candidate should be able to correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

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.