Job description

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.
Join our rapidly growing and fast paced health insurance organization in the Springfield area. The ideal candidate in this position generally has insurance background, or claims paying experience and is responsible for the timely adjudication of claims (medical accident, dental, life, etc.) in support of the different product lines administered by Wellfleet.
In this role, you will…

• Learn the basics of insurance
• Understand the products serviced at Consolidated Health Plans
• Learn how to navigate the LuminX claim system
• Understand the claim adjudication process
• Process claims in accordance with the plan document in a timely and accurate manner
• Perform detailed analysis of medical treatment submitted for payment
• Investigate and administer the terms of coverage
• Prepare High Dollar files for review from carriers
• Communicate with Policyholders, Claimants, Providers and Agents as required
• Manage Individual mailbox according to company standard
• Maintain a working knowledge of State/Federal insurance regulations and mandates
• Maintain product/system knowledge 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

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 other 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.

Job Type: Full-time

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