WebTPA ยท 1 day ago
Claims Examiner I
San Antonio, TX
Full-time
Onsite
Entry Level
2+ years expWebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. As a Claims Examiner, you will handle processing and adjudication for healthcare claims, including claims research and verification of medical necessities and coverage under policy guidelines.
Financial ServicesHealth Care
Responsibilities
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
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
Resolving claims appeals, researching benefits, verifying correct plan loading
Qualification
Required
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 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
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
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
Company
WebTPA
WebTPA provides customizable administration solutions and products to employers, health systems and insurance companies.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2020-11-06Acquired
2001-05-01Series Unknown
Leadership Team
Tanner Vick
Chief Financial Officer
Recent News
2025-04-18
2025-01-17
2024-05-23
Company data provided by crunchbase