Adecco has a great opportunity for a Claims Examiner position located in San Antonio, Texas. Pay starting at $21.00 per/hr. working Monday – Friday 8am to 5pm. This position is in office and is not a remote position.
The Claims Examiner & Support Specialist Level I is responsible for accurately processing health plan delegated claims, addressing provider inquiries via phone calls, and handling various administrative tasks within the department. In addition, you will contribute to organizational growth and success while upholding our Mission, Vision, and Values.
Culture and Values Expectations
We believe that workplace culture is the cornerstone of success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered, and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time.” In this role, you are expected to embody and promote our Values and defined behavioral expectations.
Integrity: Do the right thing, the right way, every time.
Be honest, uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
Compassion: Treat everyone with respect and dignity.
Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
Synergy: Collaborate to improve outcomes.
Invite and explore new opportunities, promote effective communication and teamwork, and take pride in yourself and your work.
Stewardship: Use resources responsibly and efficiently.
Implement effective strategies to attain goals, achieve maximum productivity and results, and pursue continuous learning and improvement.
Essential Job Duties & Responsibilities
Processing Health Plan Delegated Claims:
Review claim submissions for accuracy and completeness.
Verify information to ensure alignment with established guidelines.
Adjudicate claims according to policy and regulatory requirements.
Ensure accurate and timely processing of delegated claims.
Answering Phone Calls:
Handle incoming calls from healthcare providers and stakeholders.
Provide prompt and accurate responses to claims-related inquiries.
Document calls, including topics discussed and resolutions.
Address concerns and assist with claim-related issues.
Resolve problems efficiently over the phone.
Administrative Functions:
Perform administrative tasks supporting department operations.
Conduct accurate and efficient data entry.
Log disputes and track their resolution.
Process incoming mail and ensure proper distribution.
Complete additional clerical duties as assigned.
Other Duties as Assigned:
Remain flexible and take on additional responsibilities as needed.
Adapt to changes in workflows or procedures.
Collaborate with team members to achieve departmental goals.
To excel in this role, strong attention to detail, knowledge of healthcare claims processing, and effective communication skills are essential. Familiarity with health plan guidelines and the ability to stay updated on changes is important. Maintaining a customer-focused approach when handling inquiries and issues is critical to ensuring a positive experience for providers and stakeholders.
Experience
1 year of call center experience preferred
6 months of claims adjudication experience preferred
1 year of experience in a claims department is a plus
Education
High School diploma or equivalent (GED)
Knowledge, Skills & Abilities
Basic knowledge of healthcare terminology, coding, and claims processing procedures
Strong attention to detail and accuracy in data entry
Effective written and verbal communication skills
Ability to adapt to changing guidelines and procedures
Familiarity with relevant software and claims processing systems is a plus
Basic knowledge of Microsoft Office (Outlook, Word, Excel, Teams)
Data entry/typing skills (minimum 50 words per minute)
Ability to build and maintain positive working relationships
Ability to multitask as needed
Work Hours & Travel Requirements
Monday – Friday, 8:00 a.m. – 5:00 p.m., with additional time as needed
Occasional travel to medical offices for benefit education may be required
Working Conditions & Physical Requirements
Office-based roles using standard equipment (computers, phones, scanners, etc.)
This position requires regular communication (talking and hearing) and is primarily sedentary. Occasional filing may require lifting files, opening cabinets, bending, or using a step stool. Visual requirements include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
What's in this for you?
Pay starting at $21.00 p/hr.
Benefits after 30 days
Click on apply now for immediate consideration for this, Claims Examiner position in San Antonio TX!
Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
