Wellfleet
Overview
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Claims Team Lead
role at
Wellfleet . 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. Join our rapidly growing and fast paced health insurance organization in the Springfield area. The ideal candidate in this position will assist the Claims Supervisor in the technical and operational functions of the claims unit, including but not limited to: ensuring compliance with company standards and industry best practices, delivering quality services, assisting with staff training and development, and handling administrative duties associated with our accounts. Compensation : The annual base salary range is $55,000 to $67,000. Actual salaries vary based on qualifications, skills, and competencies. The total compensation package includes medical, vision and dental insurance options, life and disability coverage, 401(k), and other benefits. This description reflects Wellfleet as part of MedPro Group. Responsibilities
Communicate with Clients, Policyholders and Agents as required Assist Account Managers with questions as necessary Work with staff on professional development and identify career goals of team members Review reports (audits, inquiries, etc.) to identify trends and opportunities for process improvement and additional training Contribute agenda items for weekly claims meetings to improve service quality for customers Maintain thorough understanding of equipment, methods, and procedures Provide clear oral and written communications to staff Develop and implement training programs for Claims personnel in consultation with HR and the Claims Supervisor Maintain confidentiality Handle difficult situations and individuals professionally Motivate others to reach their potential and drive results Work independently with minimal direction Monitor timesheets and PTO while meeting staffing needs Assist Claims Supervisor with performance reviews Participate in screening and hiring processes Ensure staff responds timely to appeals, DOI complaints, inquiries, and reprocessing when needed Ensure accurate and timely processing of claims Perform random claim audits as needed Handle special projects Maintain positive relationships with internal and external customers Keep current with benefits Meet key performance measures and operating plan deliverables Adhere to client-specific and company SLAs Keep management informed of problems and issues; handle escalated issues Perform other duties as assigned Qualifications
Bachelor’s Degree preferred, or a minimum of 5 years claims processing experience Recent experience in the health insurance industry to support clients Demonstrated leadership experience Knowledge of CPT, HCPC, ICD-10 codes and medical terminology Excellent oral, written and interpersonal communication skills Ability to lead and remain calm under pressure Strong teamwork skills Flexibility in prioritizing workloads to meet changing deadlines Ability to adapt to changing situations with ease Proficient in MS Office products Why Wellfleet
Wellfleet fosters a culture of growth that enables engaged and high-performing professionals to deliver the mission and vision. Our employees are devoted to providing customer service that exceeds expectations for members and clients. Wellfleet offers a comprehensive benefits package and a competitive compensation package. General
Wellfleet is part of the MedPro Group family. We are an Equal Opportunity Employer. All Wellfleet team members are employees of MedPro Group Inc. Wellfleet delivers customer-centric accident and health insurance with quality service and uncompromising ethics. For more details, visit our careers website at: wellfleetinsurance.com/about/careers. Note: This posting reflects current information and may be subject to change.
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Join to apply for the
Claims Team Lead
role at
Wellfleet . 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. Join our rapidly growing and fast paced health insurance organization in the Springfield area. The ideal candidate in this position will assist the Claims Supervisor in the technical and operational functions of the claims unit, including but not limited to: ensuring compliance with company standards and industry best practices, delivering quality services, assisting with staff training and development, and handling administrative duties associated with our accounts. Compensation : The annual base salary range is $55,000 to $67,000. Actual salaries vary based on qualifications, skills, and competencies. The total compensation package includes medical, vision and dental insurance options, life and disability coverage, 401(k), and other benefits. This description reflects Wellfleet as part of MedPro Group. Responsibilities
Communicate with Clients, Policyholders and Agents as required Assist Account Managers with questions as necessary Work with staff on professional development and identify career goals of team members Review reports (audits, inquiries, etc.) to identify trends and opportunities for process improvement and additional training Contribute agenda items for weekly claims meetings to improve service quality for customers Maintain thorough understanding of equipment, methods, and procedures Provide clear oral and written communications to staff Develop and implement training programs for Claims personnel in consultation with HR and the Claims Supervisor Maintain confidentiality Handle difficult situations and individuals professionally Motivate others to reach their potential and drive results Work independently with minimal direction Monitor timesheets and PTO while meeting staffing needs Assist Claims Supervisor with performance reviews Participate in screening and hiring processes Ensure staff responds timely to appeals, DOI complaints, inquiries, and reprocessing when needed Ensure accurate and timely processing of claims Perform random claim audits as needed Handle special projects Maintain positive relationships with internal and external customers Keep current with benefits Meet key performance measures and operating plan deliverables Adhere to client-specific and company SLAs Keep management informed of problems and issues; handle escalated issues Perform other duties as assigned Qualifications
Bachelor’s Degree preferred, or a minimum of 5 years claims processing experience Recent experience in the health insurance industry to support clients Demonstrated leadership experience Knowledge of CPT, HCPC, ICD-10 codes and medical terminology Excellent oral, written and interpersonal communication skills Ability to lead and remain calm under pressure Strong teamwork skills Flexibility in prioritizing workloads to meet changing deadlines Ability to adapt to changing situations with ease Proficient in MS Office products Why Wellfleet
Wellfleet fosters a culture of growth that enables engaged and high-performing professionals to deliver the mission and vision. Our employees are devoted to providing customer service that exceeds expectations for members and clients. Wellfleet offers a comprehensive benefits package and a competitive compensation package. General
Wellfleet is part of the MedPro Group family. We are an Equal Opportunity Employer. All Wellfleet team members are employees of MedPro Group Inc. Wellfleet delivers customer-centric accident and health insurance with quality service and uncompromising ethics. For more details, visit our careers website at: wellfleetinsurance.com/about/careers. Note: This posting reflects current information and may be subject to change.
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