WelbeHealth · 17 hours ago
Claims Examiner
United States
Full-time
Remote
Mid Level
$69K/yr - $74K/yr
3+ years expWelbeHealth is transforming senior care by providing all-inclusive healthcare options for vulnerable populations. The Claims Examiner plays a crucial role in ensuring the timely and efficient processing of claims for specialty provider partners while adhering to regulatory and organizational standards.
Health CareHealth DiagnosticsHospital
Responsibilities
Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards
Work alongside manager to establish and maintain claims processing rules that meet all regulatory and business requirements
Assist internal and external partners with questions related to claims decisions or claims statuses
Qualification
Required
Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a complex managed care environment
Working knowledge of the health plan insurance industry and CPT/HCPCS procedures, codes and relevant federal and state regulations
Understanding of industry pricing methodologies, such as Medicare/Medi-Cal fee schedule, Diagnosis Related Groups (DRG), Multiple Procedure Payment Reduction (MPPR) and benefit interpretation and administration
In depth experience with Medicare and Medicaid claims processing
Demonstrated skills within Microsoft Office Applications & electronic claims processing systems
Strong organizational, analytical, communication and time management skills
Benefits
Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
Work/life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
Advancement opportunities - We’ve got a track record of hiring and promoting from within, meaning you can create your own path!
401k match
Healthcare coverage
A broad range of other benefits
Company
WelbeHealth
Unlocking the full potential of our most vulnerable seniors with empathy and love.
501-1000 employees
H1B Sponsorship
WelbeHealth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (1)
2023 (2)
2022 (1)
2021 (2)
Funding
Current Stage
Late StageTotal Funding
$61.23M2020-02-10Series C· $30M
2018-06-29Series B· $15M
2017-02-08Series A· $15M
Leadership Team
Si France
Founder & CEO
Becca Miller Rose
Chief Operating Officer
Recent News
2025-09-02
2025-07-08
2025-06-27
Company data provided by crunchbase