Claims Examiner I - CHCS Services, Inc

Claims Examiner I

About the company

Who we are:

Wellcove, by CHCS Services is a company positioned for growth and excellence. It may not be an exciting time in the marketplace, so we aim to shake things up. We are looking at acquiring more companies and we have already begun to place a larger investment in technologies and tools for our associates and our customers.

Our story

We’ve been in business for over 30 years. We are a global company with delivery centers in the USA and INDIA. CHCS is an award-winning insurance third-party administrator (TPA) of senior health products. We are in the business of providing state-of-the-art administrative support services and customized care solutions to manage policies and claims. CHCS Supports some of the largest senior market insurance companies in the world. Processing hundreds of thousands of claims every year.

About you:

Are you looking for an opportunity to be a solid contributor to a growing company's success by applying your tremendous focus on detail and customer services skills? We are looking for a candidate who is seeking a position offering the opportunity to develop new skills with a growing company.

The ideal candidate for this role should possess a strong work ethic, excellent communication skills, critical thinking abilities, organizational skills, is comfortable with being on camera in a remote environment for extended periods of time, understands the responsibilities of working from home, and is comfortable with speaking with customers on the phone. The ideal candidate is viewed as a team player and can easily be spoken of as a collaborator in past positions.

Location: Remote

Travel required: none.

Job Summary:

Responsibilities:

To perform these jobs successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Processing complex HP/AD/ICU claims.
• Making outbound calls to obtain information.
• Should be able to prioritize work and adjudicate claims as per turnaround time.
• Working independently on researching, reviewing, summarizing, and recommending a course of action on claim.
• 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 resolve 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

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 positive approach and open to learn process dynamics.
• Ready to handle work pressure and ensure deliverables within timelines.

Education and Experience:

• High School Diploma required.
• Excellent communication skills, both verbal and written are required.
• Working knowledge of Microsoft Office

 Physical Requirements:

The physical demands described here are representative of those that must be met by an associates to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the associates is regularly required to sit for prolonged periods of time sitting at a desk working on a computer. The associate frequently is required to use hands to finger, handle, or feel and reach with hands and arms. The associates are occasionally required to walk and talk or hear (within normal range).  The associates must regularly lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, and ability to adjust focus.