Wellcove

Customer Support

• Provide customer service in a call center environment by receiving and responding to telephone inquiries from policyholders, beneficiaries, providers, agents, and others
• Provide information and assistance regarding Medicare Supplement and Life Policies
• Verify benefits and claims status by accessing and updating software system data within company response standards
• Research company records to answer insurance questions, perform routine transactions, and retrieve results from an online terminal
• Maintain working knowledge of company products and services
• Comply with privacy, confidentiality, and private health information regulations
• Provide written and oral communication regarding inquiry status and resolution
• Initiate and complete Call Tracks, checklists, and supportive clerical responsibilities
• Work various shifts as required

Customer Service Representative, Contact Center

• Provide customer service in a call center environment by receiving and responding to telephone inquiries from policyholders, beneficiaries, providers, agents, and others.
• Provide information and assistance regarding CHCS third-party administrator clients, including Medicare Supplement and Life Policies.
• Verify benefits and claims status by accessing and updating software system data within company response standards.
• Research company records, perform routine transactions, and retrieve results from an online terminal.
• Maintain working knowledge of company products and services.
• Comply with privacy, confidentiality, and private health information regulations.
• Provide written and oral communication regarding inquiry status and resolution.
• Initiate and complete Call Tracks, checklists, and supportive clerical responsibilities.
• Work various shifts as required.
• Work collaboratively while remaining accountable and working remotely and independently.

Contact Center Customer Service Representative

• Interact professionally with other business units to gather and analyze data needed to properly adjudicate claims and documentation of claims files.
• Review requests involving Power of Attorney, Guardianship and Authorizations to Release Information.
• Assist the Claims team in requesting medical documentation to adequately adjudicate long-term care eligibility.
• Reviewing the documents received to determine if complete and accurate.
• Assist Claims Management with assigning work activities to associates within our workflow.
• Respond professionally and timely to customer inquiries.
• Ensure service calls are made in a timely, efficient and knowledgeable manner.
• Follow up on any outstanding documentation with additional correspondence, reviewing fax failures, and reviewing any returned mail.
• Contact providers and customers to obtain accurate contact information.
• Maintain current knowledge of federal, state, and insurance regulations and requirements.
• Maintain working knowledge of all company and services pertaining to business segment.
• Maintain working knowledge and proficiency in company claims and administrative software systems as well as Microsoft applications.
• Maintain client and company quality and production standards.
• Maintain knowledge of applicable company policies and procedures.
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information.
• Other duties may be assigned

Claims Support Representative

General

• Collect, interpret, and validate data from multiple sources, ensuring accuracy and consistency
• Create, maintain, and manage advanced reporting, dashboards, and BI solutions
• Perform and document data analysis, validation, and mapping/design to improve reporting quality
• Review and enhance existing systems, and collaborate with teams to integrate new reporting tools
• Conduct market or operational research to identify trends and support strategic decisions
• Develop and implement data collection systems to optimize statistical efficiency and data quality
• Prepare executive-level reports summarizing trends, patterns, and forecasts using relevant data
• Work with management and stakeholders to gather requirements, provide updates, and build relationships
• Maintain compliance with data handling policies and ensure confidentiality of sensitive information
• Identify process improvements to streamline reporting workflows and reduce errors
• Analyze EVV data to identify missed visits, documentation inconsistencies, and compliance risks
• Monitor visit verification trends and recommend corrective actions
• Partner with operations to strengthen oversight and ensure adherence to state and federal EVV requirements
• Perform monthly reporting
• Other projects as defined

EVV Reporting Specialist

Scheduling Coordinator

• Making outbound calls to complete assessment scheduling
• Answering inbound phone calls for messages left from outbound calls
• Each day, handling a total of at least 50 phone calls (a combination of inbound and outbound calls)
• Receiving a score of 85% or greater on QA scores (2 completed each month)
• Not exceeding 30-minute meal and break times daily
• Averaging 25% or less on After Call Work Time
• Team collaboration
• Other projects as defined

Account Manager

• Serve as a point of contact for clients utilizing Wellcove’s EVV and Facility platforms, addressing inquiries and resolving issues promptly.
• Assist claimants, caregivers, home care agencies, and facilities in ongoing inquiries regarding the EVV and Facility platforms.
• Provide training and guidance to clients on the use of EVV and Facility platforms, tools, and processes.
• Gather required information from clients accurately record data in Wellcove’s platforms/systems.
• Maintain organized documentation for all client interactions, training sessions, and compliance activities.
• Provide outstanding customer service via phone and email, displaying professionalism, empathy, a sense of urgency, and a genuine willingness to help.
• Independently process caller requests accurately and promptly in Wellcove’s proprietary system and escalate as appropriate.
• Comply with customer support objectives and performance standards.
• Effective use of process resources to gain knowledge base and ensure the delivery of accurate information and error-free processing of requests.
• Other duties as assigned.

Account Coordinator – EVV & Assessment Services

QA Engineer

• Review all policy administration and claim level transactions against the standard operating procedures.
• Maintain the review of all Daily and Monthly billing suspense items.
• Responsible for reviewing benefit eligibility determinations to ensure that the claim recommendations meet the contractual obligations of the policy.
• Assign and document all mechanical and financial errors as discovered.
• Maintains a strong working knowledge base of all Long-Term care products and services.
• Maintain production and quality standards established in the department.
• Participate and support policy review decisions in the appeal process.
• Monthly reporting to all engagement managers and supervisory staff on the quality results of their department and staff
• Participate in client level meetings. Create action plans as agreed upon with the client and meet all timelines and deliverables.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.
• Other duties may be assigned.
• Ability and Flexibility to work overtime as required.

Quality Assurance Specialist 2, PCU

Claims Specialist

• Manage and handle all Outbound calls and adjudicate claims.
• Adjudicating HP/AD claims.
• Handling all Outbound calls.
• Should be able to prioritize work and adjudicate claims as per turnaround time.
• Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims where an appeal or a grievance has been filed for a denied / under payment.
• To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures.
• To respond to and resolves 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.

Claims Examiner

Call Center Representative

• Provides daily directions and communication to employees so that the customer service calls are answered in a timely, efficient and knowledgeable manner.
• Provide continual evaluation of processes and procedures.
• Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.
• Provide statistical and performance feedback and coaching on a regular basis to each team member.
• Write and administer performance reviews for skill improvement.
• Provide support for employees by providing appropriate coaching, counseling, direction and resolution.
• Ensure employees have appropriate training and other resources to perform their job.
• Respond to and resolve employee relations issues expressed by team members.
• Create and maintain high quality work environment so team members are motivated to perform at their highest level.
• Address disciplinary and/or performance problems according to company policy.
• Prepare warnings and communicate effectively with employees on warnings and make effective/appropriate decisions relative to corrective action as required.
• Assist manager with daily operation of call center to include development, analysis and implementation of staffing and training.
• Work as a member/leader of special or on-going projects that are important to area/process improvement.
• Share continual responsibility for deciding how to manage the employees ensuring calls are handled efficiently and effectively.
• Establish work procedures and processes that support company and departmental standards, procedures and strategic directives.
• Communicate with upper management regarding department or employee concerns.
• Complying with company regulations regarding HIPAA, confidentiality, and private health information.

Contact Center Supervisor

Customer Support Representative

Enrollment Specialist

• Conduct high-volume outbound and inbound phone calls to insureds, provider agencies, caregivers, and independent providers regarding EVV enrollment.
• Educate callers on EVV program requirements, enrollment procedures, deadlines, and available support resources.
• Guide stakeholders through the enrollment process, ensuring all required information and documentation are obtained.
• Assist providers with complete enrollment forms, account setup, and system access.
• Verify enrollment information for accuracy and completeness.
• Document all customer interactions, enrollment activities, and case notes in the appropriate systems.
• Follow up with insureds and providers to obtain missing information and ensure timely completion of enrollment.
• Respond professionally to questions, concerns, and enrollment issues while providing exceptional customer service.
• Coordinate with internal departments and external partners to resolve enrollment-related issues.
• Monitor assigned enrollment cases and meet established productivity, quality, and service-level expectations.
• Maintain confidentiality of protected health information (PHI) and comply with HIPAA and all applicable state and federal regulations.
• Stay current on EVV program requirements, policies, and system updates.
• Build and maintain strong client relationships to ensure satisfaction and compliance with EVV requirements.
• Provide training and guidance to clients on the use of EVV and Facility platforms, tools, and processes.
• Gather required information from claimants and caregivers and accurately record data in Wellcove’s platforms/systems.
• Maintain organized documentation for all client interactions, training sessions, and compliance activities.
• Provide outstanding customer service via phone and email, displaying professionalism, empathy, a sense of urgency, and a genuine willingness to help.
• Independently process caller requests accurately and promptly in Wellcove’s proprietary system and escalate as appropriate.
• Comply with customer support objectives and performance standards
• Effective use process resources to gain knowledge base and ensure the delivery of accurate information and error-free processing of requests
• Willingness to learn new duties and technology-related skills as required.

• Provides information and assistance to providers, agents, policyholders, and others by responding to telephone inquiries from CHCS third third-party administrator clients to include Medicare Supplement and Life Policies
• Accurately provide information regarding various insurance questions by accessing and updating software system data within company response standards
• Provides service and follow-up on insurance questions by researching company records to obtain information requested by customer, performing routine transactions, and retrieving results from an online terminal
• Maintains working knowledge base of all company products and services
• Complying with company regulations regarding Privacy, confidentiality, and private health information
• Providing written and oral communication to policyholders, agents, providers, and others regarding inquiry status and resolution
• Initiate and complete Call Tracks, checklists, and supportive clerical responsibilities as necessary
• Ability and Flexibility to work various shifts as required