Claims Processor I (Part Time)

Claim Examiner
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.
This is a full-time in-office position: Anticipated training class start dates: Schedule Monday to Friday 8:00am - 4:30pm Central Time for 4 weeks
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.
Day-to-day processing of claims for accounts:
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).
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.

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-9 coding required.
• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
• Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
• 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
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
Benefits for interns and part-time employees may differ.
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.