Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
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
- High school or GED
Years of Experience:
- 1+ years, salary commensurate on years
- Claims processing, including UB, 1500 and dental
- Medical terminology
- CPT/HCPC and ICD10 coding
- Medicaid and Medicare