Teams at GuideWell

Manages maternity cases for expectant mothers, including high-risk pregnancies, through patient assessment, care coordination, discharge planning, treatment-plan monitoring, resource identification, cost-effective care planning, utilization review, and health-plan authorization. Collaborates with patients, families, providers, employers, and community resources while documenting goals, outcomes, and care plans. Requires an RN license, clinical nursing experience, and patient assessment expertise.

Handles inbound calls from healthcare providers and members, resolving claims, benefits, and customer service issues. Researches appeals, benefit questions, and network providers; escalates complex cases and collaborates with benefit consultants. Tracks client concerns, identifies members needing additional support, trains customer service staff, and assists with special projects. The role is fully in-office in San Antonio and requires weekday availability between 7:00 a.m. and 7:00 p.m. CST.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and clinical edits. Investigates and recovers overpayments, handles appeals and complaints, interprets medical records, verifies plan loading, and authorizes payments. The role requires meeting production standards, maintaining accurate records, communicating with providers and clients, and using claims, coding, and Microsoft applications.