Claims Examiner I: Healthcare Claims Adjudication

WebTPA; San Antonio (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, vision, life and all‑

Disability programs

Flexible schedules after training

Paid time off

Job summary

WebTPA, a GuideWell Company, is a healthcare third-party administrator seeking a Claims Examiner for in-office processing and adjudication of healthcare claims in San Antonio, TX. The role includes claims research, verification of medical necessity, and applying policy guidelines.

Training starts 12/7/2026, with a Monday–Friday 8:00am–4:30pm schedule. Ideal candidates have 2+ years of related experience, familiarity with CPT/ICD-9 coding, and strong analytical and communication skills.

Qualifications

• 2+ years related work experience.
• Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
• Knowledge of CPT and ICD-9 coding.
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits.
• Ability to learn quickly and multitask.
• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
• Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
• Review of multiple surgical procedures and establishment of reasonable and customary fees.

Responsibilities

• Day-to-day processing of claims for accounts (medical, dental, vision, and mental health).
• Claims processing and adjudication.
• Claims research where applicable.
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines.
• Incumbents are expected to meet and/or exceed production standards.

Skills

Claims processing

Adjudication

CPT coding

ICD-9 coding

HIPAA knowledge

Detail oriented

Analytical thinking

Communication skills

Conflict resolution

Microsoft Office

Education

High school diploma or GED

Some college courses (preferred)

Tools

Microsoft Windows

Excel

Word

Job description

WebTPA, a GuideWell Company, is a healthcare third-party administrator seeking a Claims Examiner for in-office processing and adjudication of healthcare claims in San Antonio, TX. The role includes claims research, verification of medical necessity, and applying policy guidelines.

Training starts 12/7/2026, with a Monday–Friday 8:00am–4:30pm schedule. Ideal candidates have 2+ years of related experience, familiarity with CPT/ICD-9 coding, and strong analytical and communication skills.