Claims Adjudication Specialist — Independent, Detail‑Driven

Wellcove; Pensacola (FL); Hybrid; USD 36,000 - 48,000; Full time

Job summary

Wellcove in Pensacola is seeking a dedicated Claims Adjudication Specialist to manage HP/AD claims and handle outbound calls, researching medical reports to determine course of action.

You will interpret client guidelines, ensure HIPAA compliance, respond to emails, and calculate claim amounts while prioritizing turnaround times. This role requires strong English, mathematics and medical knowledge, with the ability to work independently in a fast-paced, team-oriented environment.

Qualifications

• Strong English comprehension, mathematics and medical knowledge to understand medical reports.
• Ability to research, review, summarize and recommend a course of action on claims.
• Adhere to client/company guidelines and HIPAA confidentiality requirements.

Responsibilities

• Adjudicating HP/AD claims.
• Handling all outbound calls.
• Prioritize work and adjudicate claims within turnaround times.
• Research, review, summarize, and recommend a course of action on claims.
• Respond to and resolve claims received via emails.
• Calculate claim amounts for customers.
• Ensure HIPAA compliance and confidentiality.

Skills

English proficiency

Claims adjudication

Medical terminology

Independent research

Time management

Job description

Wellcove in Pensacola is seeking a dedicated Claims Adjudication Specialist to manage HP/AD claims and handle outbound calls, researching medical reports to determine course of action.

You will interpret client guidelines, ensure HIPAA compliance, respond to emails, and calculate claim amounts while prioritizing turnaround times. This role requires strong English, mathematics and medical knowledge, with the ability to work independently in a fast-paced, team-oriented environment.