Medical Claims Examiner

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.

Originally posted on Himalayas