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
Job Requirements:
- Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a complex managed care environment
- In depth experience with Medicare and Medicaid claims processing
- Demonstrated skills within Microsoft Office Applications and electronic claims processing systems
- Ability to balance competing priorities, exercise discretion, and consider all relevant factors in navigating gray areas and resolving ambiguities
Benefits of Working at WelbeHealth: Apply your claims expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
- Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
- Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
- Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
- And additional benefits
Salary/Wage base range for this role is $68,640 - $81,395.73 / year + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
Our Commitment to Diversity, Equity and Inclusion
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Beware of Scams
Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [email protected]
Top Skills
What We Do
WelbeHealth provides full-service care to help seniors age well at home and in their community, often at no cost. Services include medical, coordination, home care, dental, transport, physical therapy, prescriptions, social activities and meals.
Founded by a seasoned group of physician entrepreneurs, our leadership team hails from leading payer and provider organizations such as GoHealth Urgent Care, BAYADA Home Health, AirStrip Technologies, Evolent Health, and On Lok.
With funding from leading venture investors, we're looking for team members who are inspired to help us deliver on our mission of unlocking the full potential of the most vulnerable seniors. Our colleagues are energized by working in diverse groups toward our shared purpose, are eager to drive groundbreaking innovations, and have the courage to care for our participants with empathy and love.
