Claims Examiner I

Company Overview 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 Full‑time in‑office position: 19100 Ridgewood Pkwy, San Antonio, TX 78259 Anticipated Training Class Start Dates: 6/22/2026 Schedule Monday to Friday, 8:00 am – 4:30 pm CST for 4 weeks Impact As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. Responsibilities Day‑to‑day processing of claims for accounts: Process medical, dental, vision, and mental‑health claims Claims processing and adjudication Claims research where applicable Review and process insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic) Meet and/or exceed qualitative and quantitative production standards Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers Conduct overpayment reviews and recover overpayments; correct financial histories of patients and service providers to ensure accurate records Utilize systems to track complaints and resolutions Resolve claims appeals, research benefits, and verify correct plan loading Qualifications 2+ years related work experience Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry High school diploma or GED Knowledge of CPT and ICD‑10 coding Knowledge of COBRA, HIPAA, pre‑existing conditions, and coordination of benefits Proven judgment, decision‑making skills, and analytical ability Ability to learn quickly and multitask Proficiency in maintaining good rapport with physicians, healthcare facilities, clients, and providers Concise written and verbal communication skills, including conflict handling Proficiency using Microsoft Windows, Word, Excel, and customized programs for medical CPT coding Review of multiple surgical procedures and establishment of reasonable and customary fees Preferred 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 Benefits Medical, dental, vision, life and global travel health insurance Income protection benefits: life insurance, short‑ and long‑term disability programs Flexible schedules after training + future WAH options 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 and a comprehensive wellness program Physical Demands General Physical Demands: Sedentary work. Exerting up to 10 pounds of force occasionally to move objects. Equal Employment Opportunity We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment. #J-18808-Ljbffr