Medical Claims Examiner

About Our Client

This organization operates in the health insurance administration industry, focusing on the processing and adjudication of self-funded medical health insurance claims. It addresses the challenge of accurately managing complex claims by applying specific plan documents and third-party administrator guidelines, ensuring compliance with federal and state regulations such as HIPAA and ERISA.

About the Opportunity

The Medical Claims Examiner position is a fully remote, independent contractor role responsible for the precise and timely processing of self-funded medical claims. This role ensures claims are adjudicated accurately according to plan documents and guidelines, maintaining compliance and meeting quality and production standards. The position demands autonomy and expertise, directly impacting the accuracy and efficiency of claims management.

Responsibilities

• Review and process complex self-funded medical claims end-to-end.
• Use the WLT system daily to adjudicate claims, applying correct coding, billing, and pricing rules.
• Verify patient eligibility, benefit limits, and plan coverage exclusions per plan documents.
• Investigate claims requiring additional information such as coordination of benefits, subrogation, or medical necessity reviews.
• Ensure compliance with all federal and state regulations, including HIPAA and ERISA.
• Meet established standards for accuracy and production turnaround.

Requirements

• Proven hands-on experience adjudicating claims using the WLT software platform.
• Experience processing self-funded medical health insurance claims.
• Ability to work independently as a 1099 contractor with a secure, HIPAA-compliant home office and high-speed internet.

Pay Range and Compensation Package

Compensation is set at $30.00 per hour.

Benefits & Perks

• 100% remote work from anywhere in the U.S.
• Independence as a 1099 contractor without corporate micromanagement.
• Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.