Claims Examiner I – Part Time

GuideWell Source

. Process and adjudicate medical, dental, vision, and mental health claims .

Posted 10/2/2026part-timeRemote • Texas • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing and adjudicating medical claims, with a strong understanding of CPT and ICD-10 coding, as well as compliance with HIPAA and COBRA regulations. Proven ability to analyze complex claims, negotiate settlements, and maintain effective communication with healthcare providers and clients.

Highest-signal resume keywords

Claims Adjudication ExperienceCPT and ICD-10 Coding KnowledgeHIPAA and COBRA ComplianceDecision-Making SkillsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingMedical Record InterpretationData Entry10-Key by Touch/SightClaims Appeals ResolutionFinancial History CorrectionClaims Overpayment RecoveryNegotiation SkillsQualitative and Quantitative AnalysisClinical Edit Logic

Soft Skills

Concise CommunicationConflict ResolutionMultitasking AbilityJudgment SkillsRapport Building

Tools & Technologies

Computerized Claims Payment SystemMicrosoft WindowsMicrosoft WordMicrosoft ExcelCustomized Medical Coding Programs

Certifications & Qualifications

High School Diploma or GED

Industry Keywords

Healthcare IndustryMedical ClaimsInsurance VerificationCoordination of BenefitsPre-Existing Conditions

About the role

Key responsibilities & impact

Process and adjudicate medical, dental, vision, and mental health claims
Research claims where applicable across varying levels of complexity
Review insurance to verify medical necessity and coverage under policy guidelines using clinical edit logic
Meet and/or exceed qualitative and quantitative production standards
Facilitate claims investigations and negotiate settlements
Interpret medical records and respond to Department of Insurance complaints
Authorize payments to claimants and providers
Review and recover claims overpayments and correct financial histories
Track complaints and resolutions using designated systems
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-10 coding required
Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required
Proven judgment, decision-making skills, and ability to analyze
Ability to learn quickly and multitask
Ability to maintain good rapport with physicians, healthcare facilities, clients, and providers
Concise written and verbal communication skills, including 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
Data entry and 10-key by touch/sight

Benefits

Comp & perks

Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best
Training schedule: Monday to Friday, 8:00am to 4:30pm Central Time
Four weeks of training