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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reviewing and adjudicating long-term care claims while ensuring compliance with HIPAA and confidentiality guidelines. Proficient in utilizing claims and administrative software systems to process payments and denials accurately and efficiently.
Highest-signal resume keywords
Long-Term Care Claims ReviewHIPAA ComplianceClaims ProcessingINSPRO Software ProficiencyPolicy Benefits Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationPolicy Provision AnalysisLong-Term Care Claim FeaturesInvoice ProcessingQuality Target Achievement
Soft Skills
Timely CommunicationProfessional CorrespondenceAnalytical Skills
Tools & Technologies
INSPROMicrosoft ApplicationsClaims Software Systems
Industry Keywords
Fraud GuidelinesConfidentiality StandardsPrivate Health Information
About the role
Key responsibilities & impact- Review and adjudicate long-term care claims and policy provisions for payment or denial
- Process payment or issue denial for invoices pertaining to long-term care claims
- Identify, analyze, and apply long-term care claim product features and applicable policy benefits
- Meet or exceed management-approved production and quality targets
- Respond accurately, timely, and professionally to external and internal correspondence regarding benefits, eligibility, claim payments, denials, and explanations of benefits
- Handle inbound claim calls
- Maintain working knowledge of company services and claims, administrative, and imaging software systems
- Operate in compliance with HIPAA, fraud, confidentiality, and private health information guidelines
- Perform other duties as assigned
Requirements
What you’ll need- Working knowledge of company services pertaining to the business segment
- Familiarity with company claims, administrative, and imaging software systems such as INSPRO and Microsoft applications
- Ability to operate within HIPAA, fraud, confidentiality, and private health information guidelines
- Ability to accurately and timely review long-term care claims and policy provisions
- Knowledge of long-term care claim product features, including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Wellcove Website LinkedIn All Job Openings 1001 - 5000 employees Founded 1989 🛡️ Insurance 🏥 Healthcare ☁️ SaaS Insurance
- Healthcare
- SaaS Wellcove is a third‑party administrator (TPA) focused on the senior market and long‑term care (LTC) benefits. Its cloud‑native LTC Now platform and AssuriCare services provide automated claim administration, eligibility determination, auto‑adjudication, payment processing, digital care management, provider matching, risk evaluation/analytics, and business process outsourcing for carriers, state retirement plans, and reinsurers. The company emphasizes automation, payment integrity, and tailored administrative solutions for long‑term care and Medicare supplement administration. Claims Examiner Job not on LinkedIn 🔥 38 minutes ago 🐊 Florida – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 📋 Claims Specialist 👻 Ghost score 10% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Review and adjudicate long-term care claims and policy provisions for payment or denial
- Process payment or issue denial for invoices pertaining to long-term care claims
- Identify, analyze, and apply long-term care claim product features and applicable policy benefits
- Meet or exceed management-approved production and quality targets
- Respond accurately, timely, and professionally to external and internal correspondence regarding benefits, eligibility, claim payments, denials, and explanations of benefits
- Handle inbound claim calls
- Maintain working knowledge of company services and claims, administrative, and imaging software systems
- Operate in compliance with HIPAA, fraud, confidentiality, and private health information guidelines
- Perform other duties as assigned 🎯 Requirements
- Working knowledge of company services pertaining to the business segment
- Familiarity with company claims, administrative, and imaging software systems such as INSPRO and Microsoft applications
- Ability to operate within HIPAA, fraud, confidentiality, and private health information guidelines
- Ability to accurately and timely review long-term care claims and policy provisions
- Knowledge of long-term care claim product features, including waiver of premium, waiting period, assignment of benefits, credits, and other applicable policy benefits Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Claims Coordinator 🔥 5 hours ago OrthoFi 201 - 500 🏥 Healthcare 💼 Consulting 📣 Marketing Website LinkedIn All Job Openings Claims Coordinator processing orthodontic insurance claims for OrthoFi’s U.S. practice network. Resolving denials, recovering payments, and maintaining account integrity. 🇺🇸 United States – Remote 💵 $17 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level 📋 Claims Specialist 🚫👨🎓 No degree required Claims Examiner – Workers Compensation, CA Jurisdiction 🔥 7 hours ago Sedgwick 10,000+ employees 🏗️ Construction 💼 Consulting 🏥 Healthcare Website LinkedIn All Job Openings Claims Examiner managing complex California workers’ compensation claims for Sedgwick, a global insurance services company. Investigating, reserving, litigating, negotiating, and resolving high-exposure claims. 🇺🇸 United States – Remote 💵 $80k - $100k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 📋 Claims Specialist 🦅 H1B Visa Sponsor Senior Claims Specialist 🔥 7 hours ago CorVel Corporation 1001 - 5000 🏥 Healthcare 💼 Consulting 📦 Logistics Website LinkedIn All Job Openings Senior Claims Specialist managing complex workers’ compensation claims for CorVel, a national risk-management solutions provider. Investigating claims, managing litigation and recoveries, and negotiating outcomes remotely in California. 🇺🇸 United States – Remote 💵 $29 - $47 / hour ⏰ Full Time 🟠 Senior 📋 Claims Specialist 🦅 H1B Visa Sponsor Field Property Claims Adjuster 🔥 8 hours ago Farmers Insurance 10,000+ employees 🚘 Automotive 🏗️ Construction 💼 Consulting Website LinkedIn All Job Openings Field property claims adjuster assessing residential damage for Farmers Insurance. Investigating losses, writing estimates, and negotiating settlements across Denton-area communities. 🇺🇸 United States – Remote 💵 $27 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 📋 Claims Specialist 🦅 H1B Visa Sponsor Field Property Claims Adjuster 🔥 8 hours ago Farmers Insurance 10,000+ employees 🚘 Automotive 🏗️ Construction 💼 Consulting Website LinkedIn All Job Openings Field property claims adjuster investigating residential damage for Farmers Insurance. Evaluating losses, writing estimates, and negotiating settlements across Indiana territory. 🇺🇸 United States – Remote 💵 $26 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 📋 Claims Specialist 🦅 H1B Visa Sponsor View More Claims Specialist Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Remote jobs Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources About us Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass Resume Review AI Apply Copilot OpenClaw job finder API docs Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs