Claims Examiner I

Job not on LinkedIn

🔥 12 hours 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 14%

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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 levels of 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 and negotiate settlements • Interpret medical records and respond to Department of Insurance complaints • Authorize payments to claimants and providers • Review and recover claims overpayments • Correct patient and provider financial histories to ensure accurate records • Track complaints and resolutions using designated systems • Resolve claims appeals • Research benefits and 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

🏖️ Benefits

• Full-time position • Training schedule: Monday to Friday, 8:00am to 4:30pm Central Time • Four weeks of training • Equal Employment Opportunity commitment and consideration for all qualified applicants