Healthcare Claims Examiner: Remote Options

WebTPA; United States; Sur place; USD 45 000 - 65 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Global travel health insurance

Flexible schedules after training

Remote/WAH options after training

Résumé du poste

WebTPA, a GuideWell Company, is a healthcare third-party administrator with 30+ years of experience. The Claim Examiner role focuses on processing and adjudicating medical, dental, vision, and mental health claims, with research and policy verification as core duties.

Ideal candidates bring 2+ years of claims experience on a computerized system, CPT/ICD-9 knowledge, and strong analytical and communication skills. Training starts in the fall; on-site hours are Mon-Fri, Central Time.

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.
• Strong judgment, decision making and analytical ability.
• Ability to learn quickly and multitask.

Responsabilités

• Day-to-day processing of claims for accounts (medical, dental, vision, mental health).
• Claims processing and adjudication; claims research where applicable.
• Reviews and processes insurance to verify medical necessities and coverage.
• Investigate and administer overpayments; track complaints and resolutions.
• Resolve claims appeals and verify correct plan loading.

Connaissances

Claims processing

Adjudication

Research

Analytical thinking

Written & verbal communication

Formation

High school diploma or GED

Outils

Microsoft Word

Excel

Windows OS

Description du poste

WebTPA, a GuideWell Company, is a healthcare third-party administrator with 30+ years of experience. The Claim Examiner role focuses on processing and adjudicating medical, dental, vision, and mental health claims, with research and policy verification as core duties.

Ideal candidates bring 2+ years of claims experience on a computerized system, CPT/ICD-9 knowledge, and strong analytical and communication skills. Training starts in the fall; on-site hours are Mon-Fri, Central Time.