Claims Examiner I

Job not on LinkedIn

🔥 4 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 18%

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Process medical, dental, vision, and mental health claims • Perform claims processing and adjudication across varying claim complexity • Research claims where applicable • Review and process insurance to verify medical necessity and coverage under policy guidelines using clinical edit logic • Meet or exceed qualitative and quantitative production standards • Facilitate claims investigations • Negotiate settlements • Interpret medical records • Respond to Department of Insurance complaints • Authorize payments to claimants and providers • Review and recover claim overpayments • Correct patient and service-provider financial histories • Track complaints and resolutions in applicable systems • Resolve claims appeals • Research benefits • Verify correct plan loading

🎯 Requirements

• 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-10 coding required • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required • Proven judgment and decision-making skills • Ability to analyze • Ability to learn quickly and multitask • Ability to maintain good rapport with physicians, healthcare facilities, clients and providers • Concise written and verbal communication skills, including the ability to handle conflict • Proficiency using Microsoft Windows and Word, Excel, and customized medical CPT coding programs • Experience reviewing multiple surgical procedures and establishing reasonable and customary fees • Data entry and 10-key by touch/sight preferred

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, Short- and long-term disability programs • Flexible schedules after training • Work-from-home options after training • Leave programs to support personal circumstances • Retirement Savings Plan with employer contribution and employer match • Paid time off • Volunteer time off • 11 holidays • Additional voluntary benefits • Comprehensive wellness program