Job Description

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

The Claims Administrative Clerk provides administrative and clerical support to the Claims Management Team and the Claims Department.

Assists Claims Management team with providing key performance information to Senior Management in order to ensure operational success:
* Organize and maintain files, maintains the Work in Progress (WIP) Report and the KPI report to measure processor success.
Data Entry of claims:
* Log Inpatient Claims into claims database for purpose of ensuring timely filing.
* Complete data entry of specialty claims as well as Form 1500 claims in a timely manner
Maintain and manage rejected claims and returns those claims back to the submitting provider in a timely manner:
* Notifies providers when a claim is received for a non-Health Choice member
* Prepare and distribute correspondence to provider and/or members for all lines of business
* Maintain a log of HCA rejected claims
* Report findings to department management
Assist with logging and tracking claims that are routed to external departments within the company:
* Maintain and update Medical Review Log every day
* Route pended medical claims to the Medical Review Nurse within two (2) days of pending date
* Ensure completion of pends within ten (10) business days of pending date


Knowledge of medical terminology
Knowledge of ICD-9/ICD-10 (when applicable)
Knowledge of CPT Codes and HCPCs codes

Computer experience necessary, including utilizing10-key
Effective time management and organizational skills
Effective interpersonal and communication skills

File alphanumerically and chronologically
Read, write and orally communicate at a professional level
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
Must possess a strong ability in logic and interpretation

High School Diploma or equivalent GED preferred
Some college preferred in business or health care administration

At least two (2) years of secretarial and clerical experience in office environment

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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