Senior Claims Examiner

Job description

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Senior Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Essential Job Duties: - Examine claim records and forms to investigate and resolve first level disputes, including completion of acknowledgement and determination letters - Review and process second level claims, such as adjustments and corrected claims - Work closely with leadership on identified trends related to improper processing and claim-related concerns or discrepancies that result in a dispute - Assist the team in carrying out departmental responsibilities and collaborate with others to support short- and long-term goals and priorities - Establish and maintain effective working relationships with team and collaboration with interdepartmental staff and leadership - Work closely with leadership on identified t...