Claims Examiner
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 Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Essential Job Duties: Examine, review and process claims according to contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards Ensure claim timeliness processing standards are being met Work alongside manager to establish and maintai