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.
Key Skills: Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claims processing and familiarity with medical coding systems (CPT, ICD, HCPCS) to understand and interpret medical procedures and diagnoses.
SUMMARY
- A Healthcare Complex Claims Specialist is responsible for the thorough investigation, adjudication,



and processing of complex healthcare claims in adherence to industry regulations and organizational policies. This role requires a deep understanding of analyzing medical records, healthcare coding systems (e.g., CPT, ICD-10, HCPCS) to accurately assess claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.
- Ability to review and analyze complex medical documentation with a high degree of accuracy to prevent errors in claims processing.
- Evaluate claims against established guidelines, contracts, and regulatory requirements.
- Conduct detailed research on complex claims, pre-existing conditions, and other intricate scenarios.
- Analyze medical records, policy documents, and other relevant information to make informed claim decisions.
- Demonstrate proficiency in healthcare coding systems (e.g., CPT, ICD-10, HCPCS, Revenue codes, medical terminologies, Human Anatomy, Inpatient Vs. Outpatient claims) to accurately assess claims.
- Provide transparent

📌 Claims - Associate (Delhi)
🏢 Wellcove
📍 Delhi