Claims Examiner I

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    "ExternalDescriptionStr": "<p><strong>Get To Know Us!</strong></p><p>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.</p><p><strong>Key position details:&nbsp;</strong></p><ul><li>This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259</li><li>Training schedule Monday to Friday 8:00am - 4:30pm CST for 4 weeks</li></ul><p><strong>What is your impact?</strong><br>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.<strong>&nbsp;</strong></p><p><strong>What Will You Be Doing:&nbsp;</strong></p><ul><li>Day-to-day processing of claims for accounts:<ul><li>Responsible for processing of claims (medical, dental, vision, and mental health claims)</li><li>Claims processing and adjudication.</li><li>Claims research where applicable.&nbsp;</li><li>Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).</li><li>Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.</li></ul></li><li>Investigation and overpayment administration:<ul><li>Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.</li><li>Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.</li><li>Utilize systems to track complaints and resolutions.&nbsp;</li></ul></li><li>Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.&nbsp;</li></ul><p><strong>What&nbsp;You Must&nbsp;Have:&nbsp;</strong></p><ul><li>2+ years related work experience.</li><li>Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.</li><li>High school diploma or GED&nbsp;</li><li>Knowledge of CPT and ICD-10 coding required.&nbsp;</li><li>Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.&nbsp;</li><li>Must possess proven judgment, decision-making skills and the ability to analyze.&nbsp;</li><li>Ability to learn quickly and multitask.</li><li>Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.&nbsp;</li><li>Concise written and verbal communication skills required, including the ability to handle conflict.&nbsp;</li><li>Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.&nbsp;</li><li>Review of multiple surgical procedures and establishment of reasonable and customary fees.</li></ul><p><strong>What We Prefer:&nbsp;</strong></p><ul><li>Some college courses in related fields are a plus.</li><li>Other experience in processing all types of medical claims helpful.&nbsp;</li><li>Data entry and 10-key by touch/sight&nbsp;</li></ul><p><strong>What We Can Offer YOU!</strong></p><p>To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:</p><ul><li>Medical, dental, vision, life and global travel health insurance</li><li>Income protection benefits: life insurance, Short- and long-term disability programs</li><li>Flexible schedules after training + future WAH options!&nbsp;</li><li>Leave programs to support personal circumstances.</li><li>Retirement Savings Plan includes employer contribution and employer match</li><li>Paid time off, volunteer time off, and 11 holidays</li><li>Additional voluntary benefits available and a comprehensive wellness program</li></ul><p>Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.</p><p>General Physical Demands:&nbsp; Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.&nbsp;</p><p><br>Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.&nbsp;<br><br><i><strong>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.</strong></i></p>",
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