Job Description

Location: Health Choice Management Co.
Posted Date: 10/7/2020

Position Purpose: Claims Processors adjudicate incoming claims in accordance with policies, procedures, and guidelines, as outlined by Health Choice, regulatory requirements and contractual agreements. Processors are subject to production and quality standards in order to help ensure claims are processed correctly the first time.

  • Adjudicate claims according to regulatory, contractual and health plan requirements
  • Pre-screen accuracy of EDI submissions through review of data elements in claims system
  • Verify claim is not duplicate of previously submitted claim
  • Keep updated with processing manual and other educational/training materials
  • Know and adjudicate claims according to COB provisions
  • Identify and refer TPL issues to appropriate department
  • Identify and refer medical review claims to appropriate department
  • Identify and refer potential FWA claims to appropriate department
  • Identify opportunities for provider education
  • Identify opportunities for process improvement, including auto adjudication

Education / Experience / Other Requirements

Education:

  • High school or GED

Years of Experience:

  • 1+ years, salary commensurate on years

Specialized Knowledge:

  • Claims processing, including UB, 1500 and dental
  • Medical terminology
  • CPT/HCPC and ICD10 coding
  • Medicaid and Medicare

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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