Life AD&D Claims Examiner I

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.

What is your impact?
As a Claim Examiner, you will handle processing and adjudication for Life and AD&D claims. This will include significant claims research where applicable and will range between claim complexity.

Key position details:

• Training Hours Monday to Friday 8:00am to 4:30pm Central Time
• Full Time position
• Onsite 6535 SH 161 Irving Texas 75063

What Will You Be Doing:

• Day-to-day processing of claims for accounts:
  
  
  
  • Responsible for processing of 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:
  
  
  
  • 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.

Qualifications:

• 2+ years related work experience
• Experience working with Life and AD&D policies
• Claims examiner/adjudication experience in the healthcare industry.
• High school diploma or GED
• Must possess proven judgment, decision-making skills and the ability to analyze.
• Ability to learn quickly and multitask.
• Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
• 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.

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.