Claims Support Representative

Wellcove

Claims Support Associate providing administrative support duties for Prudential's Long Term Care Insurance Plans. Responsible for data analysis and customer inquiries management.

Posted 7/30/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in claims adjudication processes, including the ability to analyze complex documents and maintain compliance with federal, state, and insurance regulations. Strong customer service skills and effective communication abilities are essential for interacting with clients and business units.

Highest-signal resume keywords

Claims AdjudicationLong-Term Care InsuranceCustomer ServiceDocument AnalysisHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Document ReviewData AnalysisMathematical CalculationsPolicy WritingPresentation Skills

Soft Skills

Verbal CommunicationWritten CommunicationInterpersonal SkillsDecision-MakingAdaptability

Tools & Technologies

Claims Software SystemsMicrosoft Applications

Industry Keywords

Federal RegulationsState RegulationsInsurance RequirementsFraud PreventionConfidentiality

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

High School diploma required and previous experience in the Long-Term Care insurance industry and/or administrative preferred but not required.
Ability to read, analyze, and interpret complex documents.
Ability to respond effectively to the most sensitive inquiries or complaints.
Ability to write policies and procedures.
Ability to make effective presentations.
Excellent verbal and written communication skills.
Customer Service; Work Standards; Decision-Making; Communication; Interpersonal Skills; Integrity/Honesty and Adaptability/Flexibility.
Must have the ability to add, subtract, multiply, and divide in all units of measure.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.

Benefits

Comp & perks

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
PTO Tier
Non-exempt