Demo

Claims Examiner I

GuideWell
GuideWell Salary
Oklahoma, OK Full Time
POSTED ON 1/14/2025
AVAILABLE BEFORE 4/2/2025

Job Description

Get To Know Us!

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 :

This is a Full time in office position : 14201 Wireless Way Oklahoma City, OK 73134

What is your impact?

This job includes claim processing and adjudication, with claims research where applicable. Incumbents must meet and / or exceed qualitative and quantitative production standards. Claims processing may range in level of complexity.

What Will You Be Doing :

The essential functions listed represent the major duties of this role, additional duties may be assigned.

  • Day-to-day processing of claims for accounts (80%) :

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.
  • Investigation and overpayment administration (10%) :
  • 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. (10%)
  • What You Must Have :

  • 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.
  • 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.
  • What We Prefer :

  • 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
  • What We Can Offer YOU!

    To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to :

  • 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
  • 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.

    General Physical Demands :

    Sedentary work : Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

    We are an Equal Opportunity / Protected Veteran / Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

    About Us

    At 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, no matter who you are or where you come from.

    From students to former military to seasoned professionals, our family of mission-based companies are stronger because of the unique talents and skills of our employees. We believe everyone's contribution has the power to help people and communities achieve better health. Find your new team today.

    About the Team

    We're proud to be named a Top Workplaces 2020 employer by The Dallas Morning News and the San Antonio Express-News for a second year in a row. We're even more proud of the hard work, passion and commitment that our amazing team of employees put in day after day in order to make this achievement happen. This is what makes WebTPA a family.

    If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
    Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

    What is the career path for a Claims Examiner I?

    Sign up to receive alerts about other jobs on the Claims Examiner I career path by checking the boxes next to the positions that interest you.
    Income Estimation: 
    $48,938 - $64,891
    Income Estimation: 
    $58,790 - $76,174
    Income Estimation: 
    $63,693 - $82,116
    Income Estimation: 
    $48,938 - $64,891
    Income Estimation: 
    $58,790 - $76,174
    Income Estimation: 
    $63,693 - $82,116
    Income Estimation: 
    $63,693 - $82,116
    Income Estimation: 
    $78,860 - $101,439
    Income Estimation: 
    $78,860 - $101,439
    Income Estimation: 
    $94,044 - $119,611
    Income Estimation: 
    $94,044 - $119,611
    Income Estimation: 
    $112,758 - $147,378
    View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

    Job openings at GuideWell

    GuideWell
    Hired Organization Address San Antonio, TX Part Time
    Job Description Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30 year...
    GuideWell
    Hired Organization Address San Antonio, TX Full Time
    Job Description Job Summary The Customer Service Representative is responsible for handling inbound customer calls from ...
    GuideWell
    Hired Organization Address Irving, TX Full Time
    Job Description Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30 year...
    GuideWell
    Hired Organization Address Irving, TX Full Time
    Job Description Job Summary The Customer Service Representative is responsible for handling inbound customer calls from ...

    Not the job you're looking for? Here are some other Claims Examiner I jobs in the Oklahoma, OK area that may be a better fit.

    Claims Examiner I

    Florida Blue, Oklahoma, OK

    Claims Examiner I

    Diagnostic Clinic Medical Group, Oklahoma, OK

    AI Assistant is available now!

    Feel free to start your new journey!