Healthcare Claims Examiner I — Remote Options

GuideWell; Irving (TX); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Life and travel insurance

Flexible schedules after training

Paid time off and holidays

Work from home options

Job summary

GuideWell's WebTPA, a healthcare third-party administrator, seeks a Claim Examiner in Irving, TX to process and adjudicate medical, dental, vision, and mental health claims. You will perform claims research, verify coverage under policy guidelines, and ensure accuracy in billing and coding.

The role emphasizes analytical decision-making, strong written and verbal communication, and teamwork with providers and facilities. Training starts 12/7/2026 with a Monday–Friday schedule.

Qualifications

• Must possess proven judgment, decision-making skills and the ability to analyze.
• Concise written and verbal communication skills required.
• Knowledge of CPT and ICD-9 coding required.
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.

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.
• Engage in investigation and overpayment administration, negotiate settlements, and track resolutions.

Skills

Judgment & decision-making

Analytical ability

Communication skills

Multitasking

Education

High school diploma or GED

Tools

Windows

MS Word

MS Excel

CPT coding software

Job description

GuideWell's WebTPA, a healthcare third-party administrator, seeks a Claim Examiner in Irving, TX to process and adjudicate medical, dental, vision, and mental health claims. You will perform claims research, verify coverage under policy guidelines, and ensure accuracy in billing and coding.

The role emphasizes analytical decision-making, strong written and verbal communication, and teamwork with providers and facilities. Training starts 12/7/2026 with a Monday–Friday schedule.