GuideWell Source
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.
Claims Examiner I
Job not on LinkedIn
🕒 August 4
🤠 Texas – Remote
⏰ Full Time
🟢 Junior
🟡 Mid-level
📋 Claims Specialist
🚫👨🎓 No degree required
🦅 H1B Visa Sponsor
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GuideWell Source
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 for assigned accounts • Adjudicate claims and conduct claims research where applicable • Review insurance coverage and medical necessity under policy guidelines and clinical edit logic • Meet or exceed qualitative and quantitative production standards • Investigate claims, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payments • Review and recover claim overpayments and correct patient and provider financial histories • Track complaints and resolutions using designated systems • Resolve claims appeals • Research benefits • Verify correct plan loading
🎯 Requirements
• 2+ years of related work experience • Claims examiner/adjudication experience using a computerized claims payment system in the healthcare industry • High school diploma or GED • Knowledge of CPT and ICD-9 coding • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits • Proven judgment, decision-making, and analytical skills • Ability to learn quickly and multitask • Ability to maintain rapport with physicians, healthcare facilities, clients, and providers • Concise written and verbal communication skills, including ability to handle conflict • Proficiency with Microsoft Windows, Word, Excel, and customized medical CPT coding programs • Ability to review multiple surgical procedures and establish reasonable and customary fees • Training schedule availability Monday to Friday, 8:00am–4:30pm Central Time for 4 weeks
🏖️ Benefits
• Medical, dental, vision, life and global travel health insurance • Short- and long-term disability programs • Flexible schedules 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
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