Medical Claims Examiner

This is a fully remote position, open to applicants in United States.

📋 Description

• Review, analyze, and process intricate self-funded medical claims from initiation to completion.

• Utilize the WLT system on a daily basis to adjudicate claims, ensuring accurate application of all coding, billing, and pricing guidelines.

• Confirm patient eligibility, benefit limitations, and plan coverage exclusions based on designated self-funded plan documents.

• Identify and probe claims that necessitate additional information, including coordination of benefits (COB), subrogation, or assessments of medical necessity.

• Uphold stringent compliance with all applicable federal and state regulations, including HIPAA and ERISA standards.

• Consistently meet or surpass established quality accuracy and production turnaround benchmarks.

⛳️ Requirements

• WLT System Experience: Demonstrated, practical experience in adjudicating claims using the WLT software platform. (Candidates lacking WLT experience will not be considered).

• Self-Funded Expertise: Proven background in processing self-funded medical health insurance claims.

• Contractor Readiness: Capability to work autonomously as a 1099 contractor, managing your own remote office setup and schedule to achieve production goals.

• Technical Setup: A secure, HIPAA-compliant home office environment equipped with high-speed internet.

• TPA Experience: Previous experience in a Third Party Administrator (TPA) setting is highly desirable and will distinguish you as a candidate.

• Comprehensive knowledge of medical terminology, CPT, ICD-10, HCPCS codes, and standard billing forms (UB-04, CMS-1500).

🏝️ Benefits

• Competitive compensation package.

• Flexible work schedule allowing for work-life balance.

• Opportunities for professional development and advancement.