Medical Claims Examiner

Location: San Antonio
Posted on: June 23, 2025

Job Description:

This Jobot Consulting Job is hosted by: Merwan Zattam Are you a fit? Easy Apply now by clicking the "Apply Now" button and sending us your resume. Salary: $15 - $18.5 per hour A bit about us: Founded with a commitment to providing high-quality, compassionate healthcare, this organization has been serving the community for years with a patient-first approach. Specializing in primary care, the team of dedicated physicians and healthcare professionals focuses on preventive medicine, chronic disease management, and personalized treatment plans. With multiple locations, the group is dedicated to ensuring accessible and comprehensive care, utilizing the latest medical advancements to improve patient outcomes. Rooted in excellence and integrity, the organization strives to build lasting relationships with patients, promoting overall health and well-being. Why join us? Competitive Base Salary! Generous Benefits Package including medical, dental, vision, life! Great Opportunity for Growth! Matching 401k Job Details Job Purpose The Claims Examiner & Support Specialist Level I is responsible for accurately processing health plan delegated claims, addressing provider inquiries via phone, and handling various administrative tasks within the department. This role plays a vital part in ensuring efficient claims processing and maintaining positive relationships with providers and stakeholders. Culture and Values Expectations We believe that workplace culture is the foundation of success. Our team is committed to fostering an inclusive, collaborative, and innovative environment where every associate feels valued, empowered, and motivated to reach their full potential. As a Claims Examiner & Support Specialist, you are expected to uphold and promote our core values: Integrity: Do the right thing, the right way, every time. Maintain honesty, accountability, and confidentiality while earning the trust of colleagues and those we serve. Compassion: Treat everyone with respect and dignity. Foster inclusivity, practice patience and empathy, and assume positive intent. Synergy: Collaborate to improve outcomes. Encourage teamwork, embrace new opportunities, and communicate effectively. Stewardship: Use resources responsibly and efficiently. Strive for continuous improvement, maximize productivity, and implement strategies to achieve goals. Essential Job Duties & Responsibilities Claims Processing Review claim submissions for accuracy and completeness. Verify claim details to ensure alignment with health plan policies. Adjudicate claims following established regulatory guidelines. Ensure timely and accurate processing of delegated claims. Provider Support & Call Handling Handle incoming provider inquiries related to claims processing. Provide prompt and accurate responses to resolve claim-related issues. Document phone calls, inquiries, and resolutions appropriately. Administrative Responsibilities Perform data entry with accuracy and efficiency. Track and log disputes and monitor resolution progress. Process and distribute incoming mail related to claims. Assist with other clerical and support duties as assigned. Other Duties as Assigned Adapt to workflow changes and procedural updates. Collaborate with team members to meet departmental goals. Be flexible in taking on additional responsibilities as needed. To succeed in this role, strong attention to detail, knowledge of healthcare claims processing, and effective communication skills are essential. Staying informed of health plan guidelines and maintaining a customer-focused approach will help ensure positive experiences for providers and stakeholders. Experience 1 year of call center experience preferred. 6 months of claims adjudication experience preferred. 1 year of experience in a claims department is a plus. Education High school diploma or equivalent (GED). Knowledge, Skills & Abilities Basic understanding of healthcare terminology, coding, and claims processing. Strong attention to detail and accuracy in data entry. Excellent verbal and written communication skills. Ability to adapt to changing guidelines and procedures. Proficiency in Microsoft Office (Outlook, Word, Excel, Teams). Typing speed of at least 50 words per minute. Strong ability to establish and maintain effective work relationships. Ability to multitask in a fast-paced environment. Work Hours & Travel Requirements Monday – Friday, 8:00 a.m. – 5:00 p.m., with additional hours as needed. Occasional travel to medical offices may be required for benefit education. Interested in hearing more? Easy Apply now by clicking the "Apply Now" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance.

Keywords: , San Marcos , Medical Claims Examiner, Administration, Clerical , San Antonio, Texas