Medical Claims Examiner

4 weeks ago

Irving, United States Florida Blue Full time

Get To Know Us

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

Key position details:

  • This is a fully in office position: 8500 Freeport Parkway Irving, Texas 75063
  • Training schedule: 8:00am - 4:30pm Monday - Friday

What is your impact?
As a Medical Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity.

What Will You Be Doing:

The essential functions listed represent the major duties of this role, additional duties may be assigned.

  • Day-to-day processing of claims for accounts (80%):
    • Responsible for processing of claims (medical, dental, vision, and mental health claims)
    • Claims processing and adjudication.
    • Claims research where applicable.
    • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
    • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
  • Investigation and overpayment administration (10%):
    • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
    • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
    • Utilize systems to track complaints and resolutions.
  • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. (10%)

What You Must Have:

  • 3+ years related work experience.
  • Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
  • Recent claim processing experience within the last 5 years.
  • 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.
  • Must possess proven judgment, decision-making skills and the ability to analyze.
  • Ability to learn quickly and multitask.
  • Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
  • Concise written and verbal communication skills required, including the ability to handle conflict.
  • Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
  • Review of multiple surgical procedures and establishment of reasonable and customary fees.

What We Prefer:

  • Some college courses in related fields are a plus.
  • Other experience in processing all types of medical claims helpful.
  • Data entry and 10-key by touch/sight


What We Can Offer YOU

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits: life insurance, Short- and long-term disability programs
  • Leave programs to support personal circumstances.
  • Retirement Savings Plan includes employer contribution and employer match
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.


General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

  • Claims Examiner

    3 weeks ago

    Irving, Texas, United States Sedgwick Full time

    About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our mission is to help organizations protect their people, assets, and reputation.Job SummaryWe are seeking a highly skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing and processing...

  • Medical Claims Examiner

    5 months ago

    Irving, United States CSI Full time

    The CSI Companies is actively seeking a Medical Claims Examiner for a fast-growing, international hospital system in the Irving, TX area that Forbes recently rated among the best employers in Texas!Job Summary$18-21/hour Depending on ExperienceON-SITE, Monday-Friday 8am–5pmContract-to-hire! Opportunities for growth and advancement  Duties and...

  • Senior Claims Examiner

    3 weeks ago

    Irving, United States TalentPlug LLC Full time

    Summary:The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as, ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals...

  • Medical Claims Examiner

    4 days ago

    Irving, Texas, United States GuideWell Full time

    Job SummaryWe are seeking a highly skilled Medical Claims Examiner to join our team at GuideWell. As a Claims Processing and Adjudication Professional, you will be responsible for handling the processing and adjudication of healthcare claims, including claims research and a range of claim complexity.Key ResponsibilitiesProcess and adjudicate healthcare...

  • Medical Claims Examiner

    2 weeks ago

    Irving, Texas, United States CSI Full time

    Job SummaryThe CSI Companies is seeking a Medical Claims Examiner to join their team in the Irving, TX area. This is a fast-paced, on-site position with a competitive hourly rate of $18-21 depending on experience.Key Responsibilities:Process claims quickly and accurately, meeting a high volume of 150 claims per day.Maintain statistical and financial...

  • Claims Examiner

    2 weeks ago

    Irving, Texas, United States Sedgwick Full time

    About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our mission is to help organizations protect their people, assets, and reputation while minimizing business interruptions.Job SummaryWe are seeking a highly skilled Claims Examiner - Liability / Litigation to join our team. As a Claims...

  • Claims Team Lead

    3 weeks ago

    Irving, Texas, United States Sedgwick Full time

    About the RoleWe are seeking a highly skilled Claims Team Lead to join our team at Sedgwick. As a Claims Team Lead, you will be responsible for supervising multiple teams of examiners and technical staff for liability claims for clients. Your primary goal will be to monitor colleagues' workloads, provide training, and monitor individual claim activities. You...

  • Medical Claims Processor

    2 weeks ago

    Irving, Texas, United States PDS Health Full time

    Medical Biller Job DescriptionAt PDS Health, we're seeking a skilled Medical Biller to join our team. As a Medical Biller, you'll play a critical role in ensuring the accurate and timely processing of medical claims.Key Responsibilities:Process medical claims electronically, ensuring compliance and reimbursement accuracy.Validate claims information to...

  • Medical Claims Specialist

    1 week ago

    Irving, Texas, United States McEwen & Associates, Inc Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Medical Billing Specialist to join our team at McEwen & Associates, Inc. in Irving, TX. As a Medical Billing Specialist, you will be responsible for managing the entire billing cycle, from initial submission to final payment. Your expertise in CPT, ICD-10, and HCPCS coding will ensure accurate...

  • Medical Claims Specialist

    3 weeks ago

    Irving, Texas, United States McEwen & Associates, Inc Full time

    Job SummaryWe are seeking a highly skilled Medical Billing Specialist to join our team at McEwen & Associates, Inc. in Irving, TX. As a Medical Billing Specialist, you will be responsible for ensuring accurate and timely submission of medical claims to insurance payers.Key ResponsibilitiesClaims Submission: Submit medical claims to insurance payers in a...

  • Medical Claims Specialist

    2 weeks ago

    Irving, Texas, United States The LaSalle Group Full time

    Medical Biller Job DescriptionWe are seeking a skilled and experienced Medical Biller to join our client's team. As a Medical Biller, you will be responsible for accurately and efficiently processing medical claims, billing patients and insurance companies, and following up on outstanding balances.Key Responsibilities:Review and verify patient demographic...

  • Medical Claims Specialist

    5 days ago

    Irving, Texas, United States The LaSalle Group Full time

    We are seeking a skilled Medical Biller to join our client's team. In this role, you will be responsible for accurately and efficiently processing medical claims, billing patients and insurance companies, and following up on outstanding balances.The ideal candidate will have a strong background in medical billing and collections, excellent communication...

  • Property Claims Adjuster

    1 month ago

    Irving, Texas, United States Alacrity Solutions Full time

    Job Title: Property Desk AdjusterAlacrity Solutions is seeking a highly motivated and competent Property Desk Adjuster to join our team. As a Property Desk Adjuster, you will be responsible for determining coverage based on policy and carrier guidelines.Key Responsibilities:Handle property claims throughout the claim's lifecycle.Determine coverage based on...

  • Medical Claims Supervisor

    4 days ago

    Irving, Texas, United States Sam's Club Full time

    Job SummaryWe are seeking a highly skilled Medical Claims Lead to join our team at Sam's Club. As a Medical Claims Lead, you will be responsible for overseeing the sales floor and merchandise presentation, ensuring compliance with company policies and procedures.Key ResponsibilitiesSupervise and train associates on processes and proceduresEnsure member...

  • Medical Claims Resolution Specialist

    2 weeks ago

    Irving, Texas, United States WebTPA Employer Services, LLC Full time

    Job Summary:The Medical Claims Resolution Specialist is responsible for handling inbound customer calls from providers and members, focusing on resolving client-related issues and providing expert-level resolution to complex cases. This role requires strong communication skills and the ability to analyze complex situations.Key Responsibilities:Provide...

  • Dental Claims Specialist

    3 weeks ago

    Irving, Texas, United States PDS Health Full time

    About the RoleWe are seeking a highly organized and detail-oriented Dental Claims Specialist to join our team at PDS Health. As a key member of our team, you will be responsible for processing and managing dental claims, ensuring accurate and timely submission to insurance providers.Key ResponsibilitiesProcess and manage dental claims, including electronic...

  • Insurance Claims Specialist

    5 days ago

    Irving, Texas, United States INSHUR Full time

    About the RoleWe are seeking a highly skilled Insurance Claims Specialist to join our team at INSHUR. As a PIP Claims Handler, you will be responsible for handling first-party medical claims, arbitrations, and litigation while delivering exceptional customer service by phone and email.Key Responsibilities* Handle first-party medical claims, arbitrations, and...

  • Insurance Claims Specialist

    4 weeks ago

    Irving, Texas, United States INSHUR Full time

    Job Title: PIP SpecialistWe are seeking a highly skilled PIP Specialist to join our team at INSHUR. As a PIP Specialist, you will be responsible for handling first-party medical claims, arbitrations, and litigation while delivering exceptional customer service by phone and email.About the RoleThis is a fantastic opportunity to work with a dynamic team of...

  • Insurance Claims Representative

    2 months ago

    Irving, Texas, United States Alacrity Solutions Full time

    Job Title: Outbound Call Center RepresentativeAlacrity Solutions is a leading provider of insurance claims services, and we are seeking a highly skilled Outbound Call Center Representative to join our team.Job Summary:The successful candidate will be responsible for making outbound calls to report auto accidents and gathering claim information from adverse...

  • Insurance Claims Representative

    1 month ago

    Irving, Texas, United States Alacrity Solutions Full time

    Job Title: Outbound Call Center RepresentativeAlacrity Solutions is a leading provider of insurance claims services, and we are seeking a highly skilled Outbound Call Center Representative to join our team.Job Summary:The successful candidate will be responsible for making outbound calls to report auto accidents and obtain claim information from adverse...