WebTPA
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.
Position Details
Full time, in office: 19100 Ridgewood Pkwy, San Antonio, TX 78259
Schedule: Monday to Friday 8:00am – 4:30pm Central Time (4 weeks)
Training Class Start Date: 2/2 or 3/2
Job Description / Impact As a Claims Examiner I, you will handle processing and adjudication for healthcare claims, including claims research and a range of claim complexity.
Responsibilities
Day‑to‑day processing of claims for accounts (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
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; correct financial histories of patients and service providers to ensure accurate records
Utilize systems to track complaints and resolutions
Resolve claims appeals, research benefits, 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-9 coding
Knowledge of COBRA, HIPAA, pre‑existing conditions, and coordination of benefits
Proven judgment, decision‑making skills and 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, including conflict handling
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
Other experience in processing all types of medical claims
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 and 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 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.
Seniority Level Entry level
Employment Type Full‑time
Job Function Finance and Sales
Industries Insurance
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Position Details
Full time, in office: 19100 Ridgewood Pkwy, San Antonio, TX 78259
Schedule: Monday to Friday 8:00am – 4:30pm Central Time (4 weeks)
Training Class Start Date: 2/2 or 3/2
Job Description / Impact As a Claims Examiner I, you will handle processing and adjudication for healthcare claims, including claims research and a range of claim complexity.
Responsibilities
Day‑to‑day processing of claims for accounts (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
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; correct financial histories of patients and service providers to ensure accurate records
Utilize systems to track complaints and resolutions
Resolve claims appeals, research benefits, 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-9 coding
Knowledge of COBRA, HIPAA, pre‑existing conditions, and coordination of benefits
Proven judgment, decision‑making skills and 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, including conflict handling
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
Other experience in processing all types of medical claims
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 and 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 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.
Seniority Level Entry level
Employment Type Full‑time
Job Function Finance and Sales
Industries Insurance
#J-18808-Ljbffr