Claims Examiner I

Job not on LinkedIn

🕒 September 24

🤠 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 28%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 and clinical edit logic • Meet or exceed qualitative and quantitative production standards • Facilitate claims investigations • Negotiate settlements and interpret medical records • Respond to Department of Insurance complaints • Authorize payments to claimants and providers • Review and recover claim overpayments • Correct financial histories of patients and service providers • Track complaints and resolutions using relevant 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, learn quickly, and multitask • Ability to maintain good rapport with physicians, healthcare facilities, clients, and providers • Concise written and verbal communication skills, including ability to handle conflict • Proficiency using Microsoft Windows, Word, Excel, and customized medical CPT coding programs • Experience reviewing multiple surgical procedures and establishing reasonable and customary fees • Some college courses in related fields are a plus • Experience processing all types of medical claims is helpful • Data entry and 10-key by touch/sight

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Life insurance • Short- and long-term disability programs • Flexible schedules after training • Future work-at-home options • 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

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