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Claims Examiner
3 months ago
At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while serving as a care provider and care plan to those individuals we serve.
Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners.
**This is a fully remote position with an intended schedule of Monday to Friday, 8am to 5pm PST working hours.**
**Essential Job Duties**:
- Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards
- Work alongside manager to establish and maintain claims processing rules that meet all regulatory and business requirements
- Assist internal and external partners with questions related to claims decisions or claims statuses
**Job Requirements**:
- Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a complex managed care environment
- In depth experience with Medicare and Medicaid claims processing (professional & institutional claims)
- Demonstrated skills within Microsoft Office Applications & electronic claims processing systems
- Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
- Work/life balance - we mean it 17 days of personal time off (PTO), 12 holidays observed annually, sick time
- Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path
- And additional benefits
- _For California based applicants, the minimum salary range starts at $66,560 annually. _
Salary/Wage base range for this role is $66,560.00- $67,116.66 annually + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.
- Compensation
- $55,930—$67,116.66 USD
**COVID-19 Vaccination Policy**
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
**Our Commitment to Diversity, Equity and Inclusion**
At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
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