Claims Examiner I

GuideWell Source

. Day-to-day processing of claims for accounts.

Posted 10/27/2026full-timeSan Antonio • Texas • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims processing and adjudication within the healthcare industry, with a strong understanding of CPT and ICD-9 coding, as well as compliance with HIPAA and COBRA regulations. Proven ability to analyze claims, negotiate settlements, and maintain effective communication with healthcare providers and clients.

Highest-signal resume keywords

Claims ProcessingCPT CodingICD-9 CodingHIPAA ComplianceDecision-Making Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims ResearchData Entry10-Key by Touch/SightMedical Necessity Verification

Soft Skills

Concise CommunicationConflict ResolutionJudgmentMultitaskingRapport Building

Tools & Technologies

Computerized Claims Payment SystemMicrosoft WindowsMicrosoft WordMicrosoft ExcelCustomized Medical Coding Programs

Industry Keywords

Healthcare IndustryCOBRACoordination of BenefitsPre-Existing ConditionsDepartment of Insurance

About the role

Key responsibilities & impact

Day-to-day processing of claims for accounts.
Process medical, dental, vision, and mental health claims.
Perform claims processing and adjudication.
Conduct claims research where applicable.
Review and process insurance to verify medical necessities and coverage under policy guidelines using 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.
Review and recover claims overpayments; correct financial histories of patients and service providers to ensure accurate records.
Utilize systems to track complaints and resolutions.
Resolve claims appeals, research benefits, and verify correct plan loading.

Requirements

What you’ll need

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.
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

Comp & perks

Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, Short- and long-term disability programs
Flexible schedules after training + future WAH options!
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