Claims - Eligibility Specialist

Wellcove/CHCS-Services • Pensacola, FL

5d • Remote

About The Position

Wellcove has been recognized as the nation’s leading full-service senior market solutions provider for over 25 years. Our solutions span the insurance senior market sector, focusing on long-term care and Medicare Supplement plans. However, we don’t stop there. Wellcove also addresses challenges faced in accident & health, disability, and supplemental health insurance programs.
Our team provides individuals and their families with peace of mind knowing their insurance needs will be met in a thoughtful, efficient manner. We are able to do this because of our dedicated associates, innovative solutions, and state-of-the-art technology.
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