Claims Examiner I

Job description

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. Key position details: - This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259 - Anticipated Training Class Start Dates: 5/26/2026 - Schedule Monday to Friday 8:00am - 4:30pm Central Time for 4 weeks What is your impact?: As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties may be assigned. Day-to-day processing of claims for accounts: - Responsible for processing of claims (medical, dental, vision, and mental health 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 ov...