Claims Examiner

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while serving as a care provider and care plan to those individuals we serve.

Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners.

This is a fully remote position with an intended schedule of Monday to Friday, 8am to 5pm PST working hours. 

Essential Job Duties:

· 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

Job Requirements:

· Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a complex managed care environment

· In depth experience with Medicare and Medicaid claims processing (professional & institutional claims) 

· Experience navigating manual processes for pricing Medicare and Medi-Cal claims with efficiency 

· Demonstrated skills within Microsoft Office Applications & electronic claims processing systems

Benefits of Working at WelbeHealth: Apply your claims expertise in meaningful ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

· 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!

· And additional benefits

*For California based applicants, the minimum salary range starts at $66,560 annually. 

Salary/Wage base range for this role is $66,560.00- $67,116.66 annually + Bonus + Equity. WelbeHealth offers competitive total rewards package that includes, 401k match, healthcare coverage and a broad range of other benefits. Actual pay will be adjusted based on experience and other qualifications.