Claims Examiner III - Health Insurance

Claims Examiner III - Health Insurance City: Tampa State/Province: Florida Posting Start Date: 10/31/25 Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. For additional information, visit us at www.wipro.com. Job Description:

Job Description

Role Purpose As a Claims Processor you'll be responsible for reviewing and processing insurance claims to determine the appropriate action to be taken. This role involves gathering information, evaluating claims for validity, and ensuring that all necessary documentation is complete. This position will require you to be in office for the first 8 weeks of training and then will go to remote, WFH. The office is located in the Tampa Bay, Fl area near the airport. ͏ Responsibilites

• Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
• Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
• Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
• Data Entry - Enter claim details and maintain accurate records within the claims management system.
• Problem resolution - Investigate discrepancies and resolve disputes related claim processing
• Rework Adjustment Experience - Should be able to perform the rework adjustment basis the provider request and internal rework/adjustment requirement.

͏ Required Skills

• ICD-9 &10 Coding
• Customer Service
• Computer skills with knowledge of Outlook. Word & Excel
• Expert knowledge with a minimum experience of 3 years in Healthcare and claims processing.
• Experience in Govt. Ops with a experience of Medicare and Retirement / Medicaid claims processing.
• Able to explain the terms, Copay, Coinsurance, Deductible and out of pocket.
• Able to describe Medicaid and Medicare eligibility in detail.
• Experience in M&R / Medicaid Rework/Adjustment claims processing preferred.
• Excellent Communication Skills (Verbal & Written)
• CMS 1500 & UB Form Experience is a PLUS!

Mandatory Skills: Claims_Processing . The expected compensation for this role ranges from $38,000 to $40,000 . Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options. Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law. Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome. Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Apply tot his job Apply To this Job