• 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.

Role Description 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. Qualifications - 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. Requirements - 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). Benefits - 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.

Role Description As a Workers' Compensation Claims billing specialist at Revecore, you will make high-volume, outbound calls to investigate, bill, and maximize payments on medical claims to insurance companies, on behalf of our clients (hospitals and medical providers). - Investigate and resolve denied workers' compensation claims. - Make high volume of outbound calls to patient employers, insurance company representatives, attorneys, and patients. - Submit bills and proper documentation to the insurance company or appropriate payer. - Review information/documentation provided by the payer if bills aren't paid correctly. - Participate in special projects to achieve goals and ensure client success. Qualifications - Working knowledge of Microsoft Office (Word, Excel, Outlook). - Technical proficiency to work on multiple computer screens and software applications simultaneously. - Ability to maintain strong performance in a fast-paced environment with productivity metrics. - Strong organizational skills while multi-tasking. - Critical thinking and problem-solving skills to find effective and efficient solutions. - Clear communication skills, both verbally and in writing. - Investigative mindset. - Experience with Coordination of Benefits and a general understanding of insurance billing (a plus, but not required). Requirements - A private, distraction-free environment to work from within your home. - On-camera presence is essential for building trust and collaboration. - A secure internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Workspace must accommodate all workstation equipment (laptop, monitor, keyboard, mouse, docking station, and headset). - Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check. Benefits - Paid training and incentive plans. - Medical, dental, vision, and life insurance benefits available on day 1. - Excellent work/life balance. - Employee Resource Groups build community and foster a culture of belonging and inclusion. - 401(k) contributions matched. - Career growth opportunities. - 12 paid holidays and generous paid time off. Training Our comprehensive training begins on your first day and lasts 8-10 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences. Success starts with training. That's why we ask all new team members to be fully present each day, participate actively, and remain on camera. Work at Home Requirements - A private, distraction-free environment to work from within your home. - On-camera presence: Being on camera is an essential part of our culture. - A secure internet connection. - Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads. - Revecore will provide you with your equipment.

Role Description The Claims Supervisor supervises a team of P&L claims examiners, providing support and assistance to ensure proper claims handling and client satisfaction. - Assist directly with client questions, concerns and/or issues. - Handle personal claim file caseload as assigned. - Assist with balancing Examiner pending files. - Reviews Examiner technical work product and reserve adequacy. - Reviews accuracy of Examiner billable hours. - Works with Clients/Account Executives/Account Managers to schedule, prepare and conduct claim file reviews. - Attend JPA or other client meetings. - Responsible for ensuring claims are listed on agendas for JPA discussion. - Review Examiner write-ups for JPA meetings for technical correctness and readability. - Approve advance/special invoices. - Review monthly trust account invoicing. - Monitor trust account balances. - Review monthly loss runs. - Review incident reports. - Other duties as assigned. Qualifications - High school diploma and 10 years related claim experience required. - Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements. - Minimum of five (5) years Property & Casualty liability claims experience required. - Minimum of two (2) years supervisory experience required. - Strong verbal and written communication skills. - Must be organized and detail oriented. Requirements - Bachelor's degree preferred. - Requires exceptional analytical and problem-solving skills. - Ensures flawless and consistent execution of client service instructions and performance guarantees. - Ability to actively review work of others via file reviews; identify coaching opportunities, act on needed coaching opportunities and position subordinates for successful development leading to advancement within the organization. Benefits - Competitive compensation. - Comprehensive benefits programs designed to support your well-being. - Career development opportunities and ongoing learning. - A collaborative, people-first culture with accessible leadership. - The opportunity to do meaningful work with global reach and local impact.