Medical Claims Examiner

3 weeks ago


Irving, Texas, United States GuideWell Full time
Job Summary

We 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 Responsibilities
  • Process and adjudicate healthcare claims, including medical, dental, vision, and mental health claims
  • Conduct claims research and investigate claims to ensure accurate processing and adjudication
  • Review and process insurance to verify medical necessities and coverage under policy guidelines
  • Meet and/or exceed qualitative and quantitative production standards
  • Facilitate claims investigation, negotiate settlements, and authorize payment to claimants and providers
  • Overpayment reviews and recovery of claims overpayment
Requirements
  • 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
What We Offer

As a WebTPA employee, you will have access to comprehensive benefits, including medical, dental, vision, life, and global travel health insurance, income protection benefits, leave programs, and a retirement savings plan with employer contribution and employer match.

About Us

At GuideWell, we are committed to making diversity, equity, and inclusion part of everything we do. We believe in hiring people who represent the communities we serve while creating a workplace that encourages a sense of belonging for everyone.



  • 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...


  • 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...


  • 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...


  • 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...


  • 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...


  • 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...

  • Team Lead

    1 month ago


    Irving, Texas, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled and experienced Team Lead to join our team. As a Team Lead, you will be responsible for supervising multiple teams of examiners and technical staff, providing technical and jurisdictional direction, and ensuring that claims are handled efficiently and effectively.Key ResponsibilitiesSupervise and manage...


  • Irving, Texas, United States Alacrity Solutions Full time

    Job Title: Outbound Call Center RepresentativeAlacrity Solutions is a leading provider of insurance claims services in North America. We are seeking a highly skilled Outbound Call Center Representative to join our team.Job Summary:The Outbound Call Center Representative will be responsible for making outbound calls to report auto accidents and gather claim...


  • 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...


  • Irving, Texas, United States Diagnostic Clinic Medical Group Full time

    Job Summary: The Client Resolution Specialist is a key role at Diagnostic Clinic Medical Group, responsible for handling complex client-related issues and providing expert-level resolution to claims and customer service inquiries. This position requires strong communication and problem-solving skills, as well as the ability to work independently and as part...


  • Irving, Texas, United States Baylor Scott & White Health Full time

    Job SummaryThe Patient Services Specialist 2 plays a vital role in ensuring high-quality, patient-centered care in a physician office, clinic, or other operational area. This position provides administrative support to patients, assisting with check-in, check-out, scheduling, insurance verification, and answering phones. The ideal candidate will have...

  • Medical Assistant

    3 weeks ago


    Irving, Texas, United States Baylor Scott & White Health Full time

    Job Summary:As a Certified Medical Assistant at Baylor Scott & White Health, you will play a vital role in delivering high-quality patient care in our Family Medicine department. Under the direction of a physician, you will assist in the examination and treatment of patients, ensuring a seamless and efficient experience.Key Responsibilities:• Assist...


  • Irving, Texas, United States PSN Affiliates Full time

    Job Title: Certified Outpatient Medical CoderAt PSN Affiliates, we are seeking a highly skilled and detail-oriented Certified Outpatient Medical Coder to join our team. As a key member of our coding team, you will be responsible for translating healthcare providers' diagnostic and procedural phrases into coded form, ensuring accurate and compliant coding...


  • Irving, Texas, United States PSN Affiliates Full time

    Job Summary:PSN Affiliates is seeking a skilled Certified Outpatient Medical Coder to join our team. As a key member of our coding team, you will be responsible for translating healthcare providers' diagnostic and procedural phrases into coded form. Your attention to detail and analytical skills will ensure accurate coding and compliance with established...

  • PIP Specialist

    2 weeks ago


    Irving, Texas, United States INSHUR Full time

    About the RoleWe are seeking a highly skilled and experienced First Party Claims Expert to join our team at INSHUR. As a First Party Claims Expert, you will be responsible for handling first-party medical claims, arbitrations, and litigation while delivering exceptional customer service by phone and email.Key ResponsibilitiesHandle first-party medical...


  • Irving, Texas, United States Amphibious Medics Full time

    Job OverviewAmphibious Medics is seeking a highly skilled Health and Safety Medical Technician to join our team in Irving, TX. As a key member of our construction site medical team, you will provide critical care and support to workers on site.Key ResponsibilitiesProvide medical care and support to workers on site, including triage, first aid, and referrals...

  • Litigation Consultant

    3 weeks ago


    Irving, Texas, United States Sedgwick Full time

    Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our team of experts is dedicated to helping organizations like yours navigate the complexities of claims management and risk mitigation.Job SummaryWe are seeking a highly skilled Litigation Consultant - Global Risk Management Specialist to join our...


  • Irving, Texas, United States Precision Orthopedics & Sports Medicine Full time

    Job DescriptionWe are seeking a highly skilled and organized Clinical Office Assistant to join our team at Precision Orthopedics & Sports Medicine.The ideal candidate will have experience in medical office management and be proficient in patient management software (EHR). They will be responsible for providing administrative and clinical support to ensure...


  • Irving, Texas, United States Precision Orthopedics & Sports Medicine Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Medical Scribe Specialist to join our team at Precision Orthopedics & Sports Medicine. As a Medical Scribe, you will play a critical role in assisting our surgeons with patient care by controlling patient flow, obtaining and documenting history and vital signs, and providing patient...


  • Irving, Texas, United States Arlington Orthopedic Association Full time

    Job DescriptionJob Summary:As a Medical Assistant at Arlington Orthopedic Association, you will play a vital role in supporting our healthcare team. Your primary responsibility will be to assist physicians with patient care, clerical, environmental, and organizational tasks.Responsibilities:Escort patients to exam rooms and assist in determining medical...