Medical Claims Examiner
# Medical Claims Examiner **Trident** · United States · `Remote` · `Contractor` 💼 **Уровень роли:** `Entry-level` 💰 **Компенсация:** `$30 – $30` 🕒 **Статус:** *Опубликовано: сегодня* · *Источник: Himalayas (JSON API)* --- ### Top Skills & Match 🎯 **Ключевой стек роли:** `[Claims-Examination]` `[Medical-Claims-Processing]` `[Health-Insurance-Claims]` `[Claims-Adjudication]` `[Insurance-Claims-Specialist]` `[Medical-Claims-Examiner]` `[Healthcare-Claims-Examiner]` `[Health-Claims-Examiner]` `[Medical-Claims-Reviewer]` `[Medical-Claim-Reviewer]` `[Claims-Examiner]` `[Medical-Claims-Adjuster]` `[Insurance-Claims-Examiner]` --- ### About the Role We are seeking a highly skilled and independent Claims Examiner to join our team on a 100% remote, 1099 contract basis. In this role, you will be responsible for the accurate and timely processing of self-funded medical health insurance claims. Because this is a fully remote, independent contractor position, we are looking for a self-starter who requires minimal supervision and has deep, hands-on experience navigating the WLT software system . Your expertise will directly ensure our claims are adjudicated accurately according to specific plan documents and TPA guidelines. Key Responsibilities - Review, analyze, and process complex self-funded medical claims from start to finish. - Utilize the WLT system daily to adjudicate claims, ensuring all coding, billing, and pricing rules are applied correctly. - Verify patient eligibility, benefit limits, and plan coverage exclusions based on specific self-funded plan documents. - Identify and investigate claims requiring additional information, such as coordination of benefits (COB), subrogation, or medical necessity reviews. - Maintain strict compliance with all federal and state regulations, including HIPAA and ERISA guidelines. - Meet or exceed established quality accuracy and production turnaround standards. Requirements Required: - WLT System Experience: Proven, hands-on experience adjudicating claims within the WLT software platform. (Candidates without WLT experience will not be considered). - Self-Funded Expertise: Demonstrated background processing self-funded medical health insurance claims. - Contractor Readiness: Ability to work independently as a 1099 contractor, managing your own remote office setup and schedule to meet production targets. - Technical Setup: A secure, HIPAA-compliant home office environment with high-speed internet. Ideal / Preferred: - TPA Experience: Previous experience working within a Third Party Administrator (TPA) environment is highly preferred and will make you a standout candidate. - Deep understanding of medical terminology, CPT, ICD-10, HCPCS codes, and standard billing forms (UB-04, CMS-1500). Why Partner With Us? - Total Flexibility: 100% remote work structure from anywhere in the U.S. - Competitive Rate: Straightforward compensation at $30.00 per hour. - Autonomy: As a 1099 contractor, you have the independence to do what you do best without corporate micromanagement. Originally posted on Himalayas
- Claims-Examination
- Medical-Claims-Processing
- Health-Insurance-Claims
- Claims-Adjudication
- Insurance-Claims-Specialist
- Medical-Claims-Examiner
- Healthcare-Claims-Examiner
- Health-Claims-Examiner
- Medical-Claims-Reviewer
- Medical-Claim-Reviewer
- Claims-Examiner
- Medical-Claims-Adjuster
- Insurance-Claims-Examiner
Наблюдалась 2026-10-02, впервые 2026-10-02, источник — Himalayas (JSON API).