Medical Claims Examiner

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Trident BPO

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2023

🤝 B2B

🏢 Enterprise

B2B • Enterprise

Trident BPO is a business process outsourcing provider that delivers customer support, contact center services, and back-office processing to companies across industries. It helps organizations reduce costs, scale operations, and improve service quality through trained agents, technology-enabled workflows, and performance management.

📋 Description

• Review, analyze, and process complex self-funded medical claims from start to finish. • Utilize the WLT system daily to adjudicate claims, ensuring all coding, billing, and pricing rules are applied correctly. • Verify patient eligibility, benefit limits, and plan coverage exclusions based on specific self-funded plan documents. • Identify and investigate claims requiring additional information, such as coordination of benefits (COB), subrogation, or medical necessity reviews. • Maintain strict compliance with all federal and state regulations, including HIPAA and ERISA guidelines. • Meet or exceed established quality accuracy and production turnaround standards.

🎯 Requirements

• WLT System Experience: Proven, hands-on experience adjudicating claims within the WLT software platform. (Candidates without WLT experience will not be considered). • Self-Funded Expertise: Demonstrated background processing self-funded medical health insurance claims. • Contractor Readiness: Ability to work independently as a 1099 contractor, managing your own remote office setup and schedule to meet production targets. • Technical Setup: A secure, HIPAA-compliant home office environment with high-speed internet. • TPA Experience: Previous experience working within a Third Party Administrator (TPA) environment is highly preferred and will make you a standout candidate. • Deep understanding of medical terminology, CPT, ICD-10, HCPCS codes, and standard billing forms (UB-04, CMS-1500).