72 applicants
Wellfleet · 3 days ago
Claims Compliance Analyst
United States
Full-time
Remote
Mid, Senior Level
$60K/yr - $70K/yr
5+ years exp
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Insider Connection @Wellfleet
Responsibilities
Proficient in navigating the LuminX claim system
In-depth understanding of the claim adjudication process
Process claims in accordance with the plan document accurately
Perform detailed analysis of medical treatment submitted for payment
Investigate and administer the terms of coverage
Understand State/Federal insurance regulations
Maintain product/system knowledge
Work independently to find problem resolutions
Implement and communicate new regulations
Develop, execute, and audit claim-related compliance activities
Monitor compliance policies and procedures
Review and implement new laws, rules, and regulations
Assist in market conduct exams
Create job aids for regulatory items
Participate in compliance meetings
Review compliance reports for accuracy
Handle claim adjustments related to regulatory requirements
Communicate issues or concerns to Manager
Perform assigned duties and tasks
Qualification
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Required
Minimum of 5 years health care claim processing experience required.
Solid understanding of Wellfleet’s policies and procedures.
Ability to design, conduct and report on compliance self-monitoring activities.
Ability to digest and understand laws/regulations as interpreted by Legal Department.
Ability to assess, prioritize and communicate risk within Claim Operations.
Strong organizational skills and attention to detail.
Strong written and verbal communication skills.
Excellent presentation and interpersonal skills.
Ability to work in a fast-paced environment, think quickly, meet deadlines, and adapt to various situations.
Ability to understand complex problems, identify root causes, and remain goal-oriented within a dynamic environment.
Ability to prioritize multiple work assignments simultaneously.
Exhibits strong work ethic.
Strong analytical skills, with the ability to effectively identify, communicate, and address potential issues.
Ability to work independently and as a team player.
Ability to work effectively with peers, as well as business areas at all levels of the organization.
Strong commitment to compliance & ethics.
Benefits
Life insurance
Health insurance
Dental insurance
Vision insurance
401(k) retirement plan
Short-term and long-term disability coverage
Flexible/dependent care spending account
Tuition reimbursement
Business casual dress
Company
Wellfleet
Wellfleet is an insurance company that provides accident and health insurance.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Kim Adler
Vice President Strategic Partnerships
Philip LaCombe
CIO
Recent News
Coverager - Insurance news and insights
2022-05-25
Company data provided by crunchbase
