Medical Claims Examiner
3 weeks ago
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
- 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
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 UsAt 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.
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