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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.
