Claims - Eligibility Specialist

Wellcove • PENSACOLA, FL

4d • Remote

About The Position

We are looking for a detail-oriented Eligibility Specialist to join our Long-Term Care team. In this role, you will review documentation and make eligibility determinations for initial claims and recertifications. This is a fast-paced, production-focused position requiring strong analytical, documentation, and communication skills. Long Term Care experience is a plus.

Requirements

• Experience in Long Term Care, healthcare, or eligibility determination preferred.
• Strong analytical, written, and verbal communication skills.
• Ability to work independently in a fast-paced, remote environment.
• Proficient in Microsoft Office and able to learn proprietary systems.
• Excellent attention to detail and organizational skills.

Nice To Haves

• Long Term Care experience is a plus.

Responsibilities

• Review and assess documentation to determine LTC claim eligibility.
• Make initial and recertification eligibility determinations accurately and timely.
• Communicate with internal teams and make outreach calls to clarify or obtain information.
• Document all findings and maintain accurate records.
• Meet production goals while ensuring quality and compliance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed