Claims Examiner I

About the role

This is a Full time in office position located at 19100 Ridgewood Pkwy, San Antonio, TX 78259. Anticipated Training Class Start Dates: 6/22/2026 or 7/20/2026. Schedule: Monday to Friday, 8:00am - 4:30pm Central Time for 4 weeks.

Responsibilities

• Day-to-day processing of claims for accounts
• Claims processing and adjudication
• Claims research where applicable
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic)
• 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
• Resolve claims appeals, research benefits, verify correct plan loading

Requirements

• 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
• 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

Qualifications

• 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

Skills

• Knowledge of CPT and ICD-9 coding
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits
• 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

Benefits

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
• Flexible schedules after training + future WAH options!
• Leave programs to support personal circumstances
• Retail 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

Pay

Details about pay are not specified in the job description.

Schedule

The schedule is Monday to Friday, 8:00am - 4:30pm Central Time for 4 weeks.