Claims Examiner I — Flexible Schedule & WAH Options

WebTPA; Oregon; Ibrido; USD 52.000 - 76.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, vision and life ins.

Global travel health insurance

Retirement savings plan with employer

Paid time off and holidays

Flexible schedules after training and

Volunteer time off and wellness

Descrizione del lavoro

WebTPA in the United States is seeking a Claims Examiner to handle processing and adjudication for healthcare claims, including research and complex case analysis. You will process medical, dental, vision, and mental health claims and verify coverage under policy guidelines.

Ideal candidates possess 2+ years of claims experience, CPT/ICD-10 knowledge, and strong communication skills. This role includes training, Monday–Friday hours, and benefits.

Competenze

• 2+ years of related work experience in healthcare claims.
• Claims examiner/adjudication on computerized claims systems.
• Knowledge of CPT and ICD-10 coding required.
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits.
• Strong judgment, decision-making and analytical abilities.
• Ability to learn quickly and multitask.
• Excellent written and verbal communication.

Mansioni

• Day-to-day processing of claims for accounts.
• Process medical, dental, vision, and mental health claims.
• Claims processing and adjudication.
• Claims research where applicable.
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines.
• Meet and/or exceed qualitative and quantitative production standards.
• Investigation and overpayment administration and recovery.
• Facilitate claims investigation, negotiate settlements, and respond to complaints.
• Overpayment reviews and correction of histories; track resolutions in systems.
• Resolve claims appeals and verify benefits.

Conoscenze

Analytical skills

Multitasking

Written and verbal communication

Decision making

Relationship building

MS Office (Word/Excel)

CPT/ICD-10 coding knowledge

Formazione

High school diploma or GED

Some college courses

Strumenti

Microsoft Word

Microsoft Excel

CPT coding software

Descrizione del lavoro

WebTPA in the United States is seeking a Claims Examiner to handle processing and adjudication for healthcare claims, including research and complex case analysis. You will process medical, dental, vision, and mental health claims and verify coverage under policy guidelines.

Ideal candidates possess 2+ years of claims experience, CPT/ICD-10 knowledge, and strong communication skills. This role includes training, Monday–Friday hours, and benefits.