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Medical Claims Examiner
Trident BPOClaims Examiner processing self-funded medical health insurance claims on a 100% remote basis. Utilizing WLT software system to ensure accurate adjudication according to guidelines.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in adjudicating self-funded medical claims using the WLT system, ensuring compliance with HIPAA and ERISA regulations while maintaining high accuracy and production standards. Proficient in medical terminology and coding practices, with the ability to work independently in a remote environment.
Highest-signal resume keywords
WLT System ExperienceSelf-Funded ExpertiseTPA ExperienceMedical Terminology ProficiencyHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationCPT CodingICD-10 CodingHCPCS CodingUB-04 BillingCMS-1500 BillingEligibility VerificationBenefit Limit AnalysisProduction StandardsQuality Accuracy
Soft Skills
Independent WorkTime ManagementAttention to Detail
Tools & Technologies
WLT SystemHIPAA-Compliant Home Office Setup
Industry Keywords
Self-Funded Medical ClaimsThird Party Administrator (TPA)Federal RegulationsState RegulationsCoordination of Benefits (COB)SubrogationMedical Necessity Reviews
About the role
Key responsibilities & impact- 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
What you’ll need- 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.
- 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).
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Trident BPO Website LinkedIn All Job Openings 1 - 10 employees Founded 2023 🤝 B2B 🏢 Enterprise B2B
- Enterprise Trident BPO is a business process outsourcing provider that delivers customer support, contact center services, and back-office processing to companies across industries. It helps organizations reduce costs, scale operations, and improve service quality through trained agents, technology-enabled workflows, and performance management. Medical Claims Examiner Job not on LinkedIn 🔥 51 minutes ago 🇺🇸 United States – Remote 💵 $30 / hour ⏳ Contract/Temporary 🟡 Mid-level 🟠 Senior 📋 Claims Specialist Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- 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
- 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.
- 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). Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs PB & Claims Analyst 🕒 July 11 Superlanet 51 - 200 ⚕️ Healthcare Insurance 🎯 Recruiter Website LinkedIn All Job Openings Epic PB & Claims Analyst supporting a Texas healthcare organization for 3 months on a remote contract. Responsible for designing, implementing, and optimizing Epic Professional Billing and Claims applications. 🇺🇸 United States – Remote 💵 $60 - $83 / hour ⏳ Contract/Temporary 🟡 Mid-level 🟠 Senior 📋 Claims Specialist Temporary Construction Defect Claims Specialist 🕒 June 5 Frank Winston Crum Insurance 51 - 200 🤝 B2B Website LinkedIn All Job Openings Temporary Specialist managing construction defect claims at Frank Winston Crum Insurance. Evaluating complex claims, negotiating with insurers, and providing timely resolutions for clients. 🇺🇸 United States – Remote 💵 $40 - $45 / hour ⏳ Contract/Temporary 🟠 Senior 🔴 Lead 📋 Claims Specialist Commercial Auto Claims Representative – Property Damage 🕒 June 2 biBerk Business Insurance 51 - 200 🤝 B2B 💸 Finance Website LinkedIn All Job Openings Commercial Auto Claims Adjuster responsible for evaluating and resolving first and third-party auto claims. Requires excellent customer service skills and strong knowledge of auto claims adjusting practices. 🇺🇸 United States – Remote 💵 $37 - $40 / hour ⏳ Contract/Temporary 🟡 Mid-level 🟠 Senior 📋 Claims Specialist Flood Claims Examiner – Independent Contractor 🕒 May 15 Taurus LLC 51 - 200 ☁️ SaaS 🤝 B2B 🏢 Enterprise Website LinkedIn All Job Openings Independent Contractor performing flood claims for Taurus, LLC with responsibilities including investigations and policyholder communication. 🇺🇸 United States – Remote ⏳ Contract/Temporary 🟡 Mid-level 🟠 Senior 📋 Claims Specialist View More Claims Specialist Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs