GuideWell Source, GuideWell Family का हिस्सा है और स्वास्थ्य सेवा वितरण, स्वास्थ्य बीमा तथा परामर्श के क्षेत्रों में कार्य करता है। कंपनी स्वास्थ्य सेवा समाधानों का विकास करके उन्हें बाजार में उपलब्ध कराती है, जिनमें रोगियों के परिणाम बेहतर बनाने और उपभोक्ता सहभागिता मजबूत करने के लिए तैयार किए गए देखभाल मॉडल भी शामिल हैं। इसकी सेवाओं में राज्य और संघीय Medicare तथा Medicaid कार्यक्रमों के लिए प्रशासनिक और दावों की प्रक्रिया संबंधी सहायता भी शामिल है, जिससे स्वास्थ्य संगठनों को विश्वसनीयता और परिचालन उत्कृष्टता पर ध्यान केंद्रित करते हुए जटिल कार्यों का प्रबंधन करने में मदद मिलती है।
Part-Time Claims Examiner I - Texas Remote
GuideWell Source is seeking a part-time Claims Examiner I to process medical, dental, vision, and mental health claims for WebTPA. The role includes coverage adjudication, claims investigations, overpayment recovery, and appeal resolution.
विवरण
- Process and adjudicate medical, dental, vision, and mental health claims
- Research claims across varying levels of complexity as needed
- Review insurance coverage and medical necessity under policy guidelines using clinical edit logic
- Meet or exceed qualitative and quantitative production standards
- Conduct claims investigations and negotiate settlements
- Interpret medical records and respond to Department of Insurance complaints
- Authorize payments to claimants and healthcare providers
- Review and recover claim overpayments and correct financial histories
- Track complaints and resolutions in designated systems
- Resolve claims appeals
- Research benefits and confirm accurate plan loading
आवश्यकताएँ
- At least two years of related professional experience
- Experience examining or adjudicating healthcare claims with a computerized claims payment system
- High school diploma or GED
- Working knowledge of CPT and ICD-10 coding
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits
- Sound judgment, strong decision-making, and analytical ability
- Ability to learn quickly and manage multiple tasks
- Ability to build positive working relationships with physicians, healthcare facilities, clients, and providers
- Clear, concise written and verbal communication skills, including conflict management
- Proficiency with Microsoft Windows, Word, Excel, and customized medical CPT coding programs
- Experience reviewing multiple surgical procedures and establishing reasonable and customary fees
- Accurate data entry and 10-key proficiency by touch or sight
लाभ
- Equal opportunity employer focused on an inclusive workplace where employees can belong and perform at their best
- Training runs Monday through Friday from 8:00 a.m. to 4:30 p.m. Central Time
- Four weeks of training