Top 13667 Smart Innovative Solutions Jobs

Claims - Examiner, Claims
Wellcove —Remote
- Full-time
- Remote
- Background check
- Anatomy knowledge
- Basic math
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Online Sales Representative
nulitics —Remote
- Part-time
- Remote
- Mid-level
- Communication skills
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Associate Attorney
Findling Law —Royal Oak, MI
- $75,000 - $150,000 a year
- Full-time
- Writing skills
- Mid-level
- Analysis skills
- Health insurance
- Dental insurance
Quick Apply
Installation Project Manager
Xirgo Technologies —Rolling Meadows, IL
- $85,000 - $95,000 a year
- Full-time
- Computer science
- Computer Science
- 5 years
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MasterCam/ Surfcam (or equivalent) CNC Programmer/Operator
IPPD,LLC —Milwaukee, WI
- $20 - $40 an hour
- Full-time
- Mid-level
- Math
- US work authorization
- Health insurance
- Dental insurance
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Rework Technician
4Front Solutions —DeLand, FL
- Full-time
- Microsoft Excel
- ERP systems
- Mid-level
- Paid training
- Health savings account
Quick Apply
8d
HVAC Controls Service Technician (2+ Years Experience)
Smart Building Services LLC —Kalamazoo, MI
- $25 - $45 an hour
- Full-time
- Microsoft Outlook
- Customer service
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Service Technician
Electronic Contracting Company —Kansas City, MO
- Full-time
- Microsoft Word
- Background check
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Energy Services Advisor (Business Development/Account Management)
Competitive Energy Services —Portland, ME
- $60,000 - $100,000 a year
- Full-time
- Hybrid work
- Data analysis skills
- Mid-level
- Office
- Health savings account
- Health insurance
Quick Apply
7d
Foreman - Environmental - Civil
Innovative Construction Solutions —Concord, CA
- $40 - $55 an hour
- Full-time
- Bilingual
- Clean driving record
- Construction site
- Health insurance
- Dental insurance
Quick Apply
Team Lead Mortgage Consultant
Newrez —Fort Washington, PA
- $15,080 - $60,000 a year
- Overtime
- Microsoft Excel
- English
- Office
- Paid parental leave
- Health savings account
Quick Apply
Lead CADD Technician
Halff —Brownsville, TX
- Background check
- 7 years
- Construction site
- Health savings account
- Paid holidays
Master Electrician/Supervisor
World Wide Stereo —Montgomeryville, PA
- $80,000 - $100,000 a year
- Full-time
- Clean driving record
- Management
- 5 years
- Paid holidays
- Health insurance
Quick Apply
HVAC Controls Service Technician (2+ Years Experience)
Smart Building Services LLC —Elkhart, IN
- $25 - $45 an hour
- Full-time
- Microsoft Outlook
- Customer service
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Driver-Semi
NRS —Nichols, NY
- $0.61 per mile
- Full-time
- No touch freight
- DOT physical examination
- Pass drug screening
- Paid training
- Paid holidays
AV Install Technician
Electronic Contracting Company —Lincoln, NE
- Overtime
- Microsoft Word
- Background check
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Driver
NRS —Columbus, OH
- $0.60 per mile
- Full-time
- Military
- No touch freight
- DOT physical examination
- Paid training
- Paid holidays
Senior Embedded Hardware Design Engineer
Nuve Controls LLC —Tustin, CA
- $165,000 - $180,000 a year
- Full-time
- Hybrid work
- Background check
- 7 years
- Master's degree
- Health insurance
- Dental insurance
Quick Apply
9d
Senior EHSS Specialist
Fiberon —Meridian, ID
- $71,000 - $110,000 a year
- Extended hours
- Microsoft Excel
- Bachelor of Science
- Research
- Health insurance
- Adoption assistance
Quick Apply
CADD Designer II, Wastewater
Halff —Tavares, FL
- Background check
- Engineering
- Pass drug screening
- Health savings account
- Paid holidays

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Claims - Examiner, Claims

Wellcove
Remote

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Job Details

Full-time

Qualifications

Anatomy knowledge
Defect resolution root cause analysis
Basic math
MFA
Root cause analysis
Medical terminology

Full Job Description

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.

Job Summary
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 where an appeal or a grievance has been filed for a denied / under payment
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

Standard Company Requirements:

Collaborative team spirit.
Accountable and able to work remotely and independently.
Able to pass background screening and drug tests pre and post hire – includes THC
Verification of high school, GED, or college diploma upon request.
Timely responses from three professional references.
Able to provide a dedicated remote work location free from background noises, interruptions, and desk clutter.
Able to provide an ongoing reliable internet connection and access to a smart phone for Multi Factor Authentication and communication purposes.

Required Skills/Abilities:

Should have knowledge of medical terminology, human anatomy with basic math knowledge of calculating simple interest, compound interest.
Should have excellent problem-solving skills with an eye for detail, to be able to do root cause analysis of complex claims
Should have a positive approach and open to learning process dynamics
Ready to handle work pressure and ensure deliverables within timelines

Education and Experience:

Experience in handling US HIP claims
Should have knowledge of ICD 10, CPT, Surgery procedures, Revenue codes, medical terminology, medical documents, Inpatient vs Outpatient claims etc.
Should have some experience in reading and comprehending medical documents

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.

Quick Apply

Refine Your Search

Smart Innovative Solutions jobs

Claims - Examiner, Claims

Online Sales Representative

Associate Attorney

Installation Project Manager

MasterCam/ Surfcam (or equivalent) CNC Programmer/Operator

Rework Technician

HVAC Controls Service Technician (2+ Years Experience)

Service Technician

Energy Services Advisor (Business Development/Account Management)

Foreman - Environmental - Civil

Team Lead Mortgage Consultant

Lead CADD Technician

Master Electrician/Supervisor

HVAC Controls Service Technician (2+ Years Experience)

Driver-Semi

AV Install Technician

Driver

Senior Embedded Hardware Design Engineer

Senior EHSS Specialist

CADD Designer II, Wastewater

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