Medical Claim Examiner

Key position details: 

• This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259 (no remote flexibility)
• Ability to start Training Class Start Date: 10/12/2026
• Training schedule Monday to Friday 8:00am - 4:30pm CST

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

What is your impact?
As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. 

What Will You Be Doing: 

• Day-to-day processing of claims for accounts:
  • Responsible for processing of claims (medical, supplemental, dental, vision, and or mental health claims)
  • Claims processing and adjudication.
  • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic)
  • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
• Investigation and overpayment administration:
  • Facilitate claims investigation, negotiate settlements, interpret medical records.
  • Overpayment reviews and recovery of claims overpayment; 
  • Utilize systems to track complaints and resolutions. 
• Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. 

Qualifications: 

• 2+ years related work experience 
• Experience reviewing medical records preferred
• Claims examiner/adjudication experience preferred
• High school diploma or GED 
• Knowledge of CPT and ICD-10 coding preferred
• Must possess proven judgment, decision-making skills and the ability to analyze. 
• Review of multiple surgical procedures and establishment of reasonable and customary fees.
• Some college courses in related fields are a plus.
• Other experience in processing all types of medical claims helpful. 
• Data entry and 10-key by touch/sight 

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Flexible schedules after training + future WAH options! 
• Leave programs to support personal circumstances.
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program