Claims Examiner I - Remote & Flexible Schedule

GuideWell; Irving (IA); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

Disability insurance

Flexible schedule

Work from home

Job summary

WebTPA, a GuideWell Company, seeks a Claim Examiner to handle processing and adjudication of healthcare claims. You will perform claims processing for medical, dental, vision, and mental health, conduct research, and verify medical necessity under policy guidelines.

Join a team focused on accuracy and compliance, with training and benefits, including HIPAA familiarity and strong communication with providers and facilities.

Qualifications

• 2+ years related work experience.
• Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
• High school diploma or GED.
• Knowledge of CPT and ICD-9 coding.
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits.
• 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.

Responsibilities

• Day-to-day processing of claims for accounts: 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.
• Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.

Skills

Claims processing

Adjudication

CPT coding

ICD-9 coding

Education

High school diploma or GED

Tools

Microsoft Windows

Microsoft Excel

Word

Job description

WebTPA, a GuideWell Company, seeks a Claim Examiner to handle processing and adjudication of healthcare claims. You will perform claims processing for medical, dental, vision, and mental health, conduct research, and verify medical necessity under policy guidelines.

Join a team focused on accuracy and compliance, with training and benefits, including HIPAA familiarity and strong communication with providers and facilities.