Claims - Eligibility Specialist

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.

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.

Key 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.

Qualifications:

• 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.

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.