Remote Claims Examiner I - Healthcare Adjudication

WebTPA; Irving (TX); On-site; USD 38,000 - 60,000; Full time

Job summary

WebTPA, a GuideWell Company, is seeking a Claim Examiner to handle processing and adjudication of healthcare claims. The role requires researching complex cases, verifying coverage, and ensuring accuracy in medical CPT coding and HIPAA-compliant practices.

Ideal candidates will have 2+ years of related experience, a high school diploma, and proficiency in Windows/Office tools. The position offers comprehensive benefits and a training class starting in December 2026.

Qualifications

• High school diploma or GED required.
• Experience in claims processing and adjudication in healthcare preferred.
• Knowledge of CPT/ICD-9 coding required.
• HIPAA knowledge and confidentiality.
• Ability to learn quickly and multitask with accuracy.
• Strong communication and problem-solving skills.

Responsibilities

• Process day-to-day claims for medical, dental, vision, and mental health accounts.
• Perform claims adjudication and research to verify coverage and necessity.
• Investigate overpayments and respond to inquiries.
• Review benefits, policy loading, and appeals as needed.
• Maintain accurate documentation and meet production standards.

Skills

Claims processing

Adjudication

CPT coding

ICD-9 coding

HIPAA knowledge

Communication

Multitasking

Microsoft Excel

Windows & Office

Education

High school diploma or GED

Tools

CPT coding software

Medical software

Job description

WebTPA, a GuideWell Company, is seeking a Claim Examiner to handle processing and adjudication of healthcare claims. The role requires researching complex cases, verifying coverage, and ensuring accuracy in medical CPT coding and HIPAA-compliant practices.

Ideal candidates will have 2+ years of related experience, a high school diploma, and proficiency in Windows/Office tools. The position offers comprehensive benefits and a training class starting in December 2026.