Claims & Customer Care Specialist, Workplace Benefits

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace.

Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market.

The ideal candidate in this position has insurance background, or claims paying experience and is responsible for the timely adjudication of claims and customer service (voluntary accident, critical illness, hospital indemnity, short term disability, etc.) in support of the different Workplace benefit product lines administered by Wellfleet.

In this role, you will…

• Evaluate, process, investigate, and manage Short Term Disability, Critical Illness, Hospital Indemnity, and/or Accident claims
• Ensure the accuracy and completeness of submitted claims
• Have a strong understanding of Voluntary benefits, HIPAA Privacy, and able to communicate claims payment decisions
• Provide accurate responses to member/participant for claim status and benefits
• Demonstrate a sense of urgency to ensure calls are answered within queue standards
• Have a strong understanding of medical terminology and ability to research medical treatment
• Must be a team player and able to interact with Clinical and Client Service teams in a professional manner
• Possess a high degree of decision-making ability
• Ability to meet tight deadlines
• Understand and apply state/federal regulations as it pertains to Voluntary benefits
• Manage work queues according to company standards
• Communicate with employer, members/participant, and agents as required
• Follow workflows as approved by management
• Respond to email inquiries in a timely and professional manner
• Ensure that all voicemail messages are returned within 24 hours
• Identify and communicate issues and concerns to supervisor
• Support and collaborate with team members as required
• Comprehend and interpret documents, such as training manuals, correspondence, certificates, and policies
• Assist in employee portal registration and/or help member as needed with claims submission process
• Other duties as assigned
  
  
  

We are looking for candidates with…

• A minimum of two years’ work experience in the insurance field, Voluntary benefits preferred
• Knowledge of medical billing codes and terminology preferred
• Cooperative and enjoys working with others as part of a team
• Responsible, and dependable with focus on attention to detail
• Excellent customer and interpersonal skills, including written and verbal communication and phone etiquette skills
• The ability to help resolve members questions at the first point of contact with patience and empathy
• Above average computer proficiency skills with Microsoft Suites and the ability to learn new company specific platforms
• Prompt and accurate follow-up with information gathering
• Strong multi-tasking and organizational skills
• Customer focused with genuine interest in helping others
  
  
  

Why Wellfleet?

Here at Wellfleet, we foster a culture of growth that enables engaged and high-performing professionals to be empowered to deliver our mission and vision.

Our employees are a team devoted to providing customer service that exceeds expectations of our members and clients. Successful team members continually look for ways to improve product delivery and value.

Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.

Are you interested in exploring a career at Wellfleet? Explore our open positions.

General:

Wellfleet is part of the MedPro Group family. As such, all Wellfleet team members are employees of MedPro Group Inc. We are an Equal Opportunity Employer. The base hourly range is $21.00 to $24.00. This range anticipates the low and high end of the wages for this position. Actual wages will vary and are based on factors such as a candidate’s qualifications, skills and competencies. Wages are one component of Wellfleet’s total compensation and benefits package, which includes medical, vision and dental insurance options, life and accident insurance, 401(k), and short-term and long-term disability insurance. For a more detailed overview, visit our careers website at: wellfleetinsurance.com/about/careers.