Claims - Claims Examiner

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-Pensacola, 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America

Job Description

Posted Thursday, September 3, 2026 at 6:00 AM

Who We Are

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.

Manage and handle all Outbound calls and adjudicate claims.

Duties/Responsibilities:

• Adjudicating HP/AD claims
• Handling all Outbound calls
• Should be able to prioritize work and adjudicate claims as per turnaround time
• Job involves working independently on researching, reviewing, summarizing, and recommending a course of action on claims
• Should have strong English comprehension, mathematics & medical science knowledge to comprehend medical reports
• To ensure claims are adjudicated as per the client/company guidelines. Provide continual evaluation of processes and procedures.
• To respond to and resolves claims received via emails.
• Candidate should be able to correctly calculate claim amounts for the customers
• Complying with company regulations regarding HIPAA, confidentiality, and private health information

At Wellcove, we strive to create an inclusive culture for all. We understand the importance of listening and incorporating various perspectives at every level of service. Our company does not discriminate based on gender identity, race, sexual orientation, age, religion, or disability.

Wellcove-Pensacola, 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America