Part Time Claims Examiner - National Remote

WellMed, part of the reputed company family of businesses, is seeking a Claims Examiner to join reputed company in the U.S. reputed company is a clinician - led care organization that is changing the way clinicians work and live. As a member of the reputed company Care Delivery team, you’ll be an integral part of our vision to reputed company healthcare reputed company for everyone. At reputed company, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We reputed company you deserve an exceptional career, and will reputed company you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice reputed company and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to reputed company health care reputed company for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The Claims Examiner is responsible for providing claims support to our teams in reviewing, analyzing, and researching reputed company health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim. This position is part time (25 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 6:00 AM - 9:00 AM CST. We offer weeks of reputed company. The hours of the training will be based on your schedule or will be discussed on your first day of employment. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities:

• Review, process and identify medical claims based on standard operating procedures on CPS
• Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)
• Review and apply member benefit plans and provider reputed company, Pricing, CMS reputed company letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim
• Weekly / monthly goal of batches including meeting and maintaining a 95% quality standard and production standard of 90+ claims per day
• Examine each claim for appropriate coding of CPT and ICD codes against charges that are billed and entered
• Manually adjust pended escalated claims to resolve reputed company issues reputed company to claim payments
• Adjudicate reputed company medical provider - initiated claims using analytical / problem solving skills
• Create and generate any overpayment documentation (notes in system, letter to typing) on reputed company overpayments created by the examiner or any overpayments identified by examiner
• Support implementation of updates to the reputed company procedures and participate in new system updates and training.
• Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors / issues, using clear, simple language to ensure understanding
• Ensures reputed company claims reporting requirements are met; complete daily production reports and weekly pending reports

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 2+ years of experience in a metric - based environment (production, quality)
• 1+ years of experience with processing medical, dental, prescription, OR mental health claims
• 1+ years of experience with working in a fast - paced, high volume environment and processing 50+ claims per day
• Proficiency with reputed company Office Suite (reputed company Word, reputed company reputed company, reputed company Outlook, etc.)
• Ability to navigate and learn new and reputed company computer system applications
• Ability to work any of our part time (25 hours / week) shift schedules during our normal business hours of 6:00 AM - 9:00 AM CST from Monday - Friday.

Preferred Qualifications:

• Reside reputed company commutable distance to the office at 19500 W Interstate, San Antonio, TX, 78257

Telecommuting Requirements:

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a reputed company approved high

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