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Claims Edit Coder Jobs in Texas (NOW HIRING)

WebTPA

Claims Examiner I

San Antonio, TX

... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...

Guidewell

Claims Examiner I

San Antonio, TX · On-site

... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...

Guidewell

Claims Examiner I

Irving, TX · On-site

... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...

Guidewell

Claims Examiner I

San Antonio, TX

... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...

WebTPA

Claims Examiner I

Irving, TX · On-site

... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...

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All JobsClaims Edit Coder JobsClaims Edit Coder Jobs in Texas

Claims Edit Coder information

What are the key skills and qualifications needed to thrive as a claims edit coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What is a claims edit coder?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are some common challenges faced by a claims edit coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.
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Claims Edit Coder jobs near you
Infographic showing various Claims Edit Coder job openings in Texas as of August 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 77% In-person, and 23% Remote job distribution.

Claims Examiner I

WebTPA

San Antonio, TX

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

WebTPA rating

8.2

Company rating: 8.2 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

141st of 303 rated insurance

Job description

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.

Key position details: 

  • This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259
  • Anticipated Training Class Start Dates: 6/22/2026 or 7/20/2026
  • Schedule Monday to Friday 8:00am - 4:30pm Central Time for 4 weeks

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: 

The essential functions listed represent the major duties of this role, additional duties may be assigned.

  • Day-to-day processing of claims for accounts:
    • Responsible for processing of claims (medical, dental, vision, and mental health claims)
    • Claims processing and adjudication.
    • Claims research where applicable. 
    • 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, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
    • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
    • Utilize systems to track complaints and resolutions. 
  • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. 

What You Must Have: 

  • 2+ years related work experience.
  • Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
  • High school diploma or GED 
  • Knowledge of CPT and ICD-9 coding required. 
  • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. 
  • Must possess proven judgment, decision-making skills and the ability to analyze. 
  • Ability to learn quickly and multitask.
  • Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. 
  • Concise written and verbal communication skills required, including the ability to handle conflict. 
  • Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. 
  • Review of multiple surgical procedures and establishment of reasonable and customary fees.

What We Prefer: 

  • 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

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands:  Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. 


Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. 
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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