Job Summary

Responsible for the oversight and timely/accurate claims adjudication for all clients assigned. Claim types would include but may not be limited to data entry, institutional, professional, dental, and adjustments to claims. This position may also have a Quality Assurance component.

Main Duties

  • Processing the different claims types to include Institutional, Professional and Dental Claims.
  • Review, research, and resolve claims in accordance with contracts and policies through the utilization of reference materials and on-line tools.
  • Processing all levels of claims procedures to include COB, Adjustments as required.
  • Addresses and takes appropriate action on Action Requests received within 48 hours of receipt.
  • Consistently maintains department minimum productivity and quality standards for adjudicating claims while maintaining established accuracy guidelines.
  • Provides feedback to unit Manager regarding plan benefits and system issues.
  • Must comply with strict privacy, integrity, confidentiality, availability and maintenance of Protected Health Information.
  • Processing claims correspondence from members and providers.
  • Provides accurate information regarding benefits, providers, claims, referrals, eligibility, pharmacy, etc.
  • Other projects as assigned.


  • High School Diploma or equivalent.
  • Basic computer skills/ Word processing/ Windows environment preferred.
  • 2 years current claims experience, preferably in a managed care environment. Institutional claims experience required.
  • CPT, ICD-9, & HCPCS proficiency.

Our Benefits

Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.

Click here to learn more about our competitive benefit package.

How to Apply

Please submit your resume to [email protected].

Additional information about our company may be found on our website