Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace.
Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market.
Come join our team! We are hiring a Claims Specialist to join the growing Claims Department of a national health insurance company. The ideal candidate will have a background in insurance and claims processing experience. They will support the timely adjudication of claims supported by our different product lines.
In this role, you will…
Learn the basics of insurance
Understand the products serviced at Wellfleet
Learn how to navigate the LuminX claim system
Understand the claim adjudication process;
To process claims in accordance with the plan document in a timely and accurate manner.
> Performing detailed analysis of medical treatment submitted for payment
> Investigation and administer the terms of coverage
> Communicate with Policyholders, Claimants, Providers and Agents as required
> Manage Individual mailbox according to company standards
> Meet and/or exceed productivity standards
> Meet and/or exceed accuracy standards
Maintain a working knowledge of State/Federal insurance regulations and mandates
Respond to email inquiries from providers and claimants
Demonstrate the ability to comprehend and interpret documents, such as training manuals, correspondence, brochures, policies etc.
Respond to customer service inquiry forms within 2 business days
Support the customer service team when required by answering incoming calls and providing issue resolution
Demonstrate a solid understanding of COB, Subrogation and HIPAA Privacy
Follow workflow as approved by management
Communicate issues, concerns etc. to supervisor
Perform other duties as assigned, or as situations dictates
We are looking for candidates with…
A minimum of one years’ work experience in the insurance field
Knowledge of medical billing codes preferred
Possess effective communication skills and be patient, resilient and stress tolerant
Cooperative and enjoy working with others as part of a team
Mature, responsible and dependable with focus on attention to detail
Above average computer proficiency skills with ability to type
Why Wellfleet?
Here at Wellfleet, we foster a culture of growth that enables engaged and high-performing professionals to be empowered to deliver our mission and vision.
Our employees are a team devoted to providing customer service that exceeds expectations of our members and clients. Successful team members continually look for ways to improve product delivery and value.
Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.
Are you interested in exploring a career at Wellfleet? Explore our open positions.
General:
Wellfleet is part of the MedPro Group family. As such, all Wellfleet team members are employees of MedPro Group Inc. We are an Equal Opportunity Employer.Remote work available.