Claims Specialist

The primary responsibilities of a Claims Specialist at CHOICE Healthcare Services include verifying insurance coverage and benefits, monitoring healthcare documents for compliance, collaborating with providers to ensure accuracy, auditing medical records, and creating claims. The role is essential in identifying errors before they reach insurance companies, making it crucial for patient care and billing accuracy.

To qualify for the Claims Specialist position at CHOICE Healthcare Services, candidates typically need at least an associate degree or equivalent experience in a healthcare role. A minimum of a high school diploma is also required, alongside relevant experience in customer service and a strong background in MediCal Dental. Having prior experience in a dental office will greatly enhance your application.

As a Claims Specialist at CHOICE Healthcare Services in San Francisco, you can expect a hybrid work schedule. You'll work in the office one day a week and remotely for four days, with flexible hours ranging from 10am-7pm or 11am-8pm PST, plus two Saturdays a month. This schedule is designed to promote work-life balance while ensuring you remain an integral part of our team.

In the Claims Specialist role at CHOICE Healthcare Services, you will utilize various tools and systems including Microsoft Excel, Word, Outlook, Teams, OneNote, and dental-specific software like Open Dental, NICE, and NexHealth. Familiarity with these systems will support your success in managing claims and ensuring accuracy in billing processes.

CHOICE Healthcare Services offers numerous career growth opportunities for Claims Specialists. The organization supports professional and personal growth through leadership training and events. As you gain experience within the role, there are chances to advance into higher positions in billing, management, or specialized areas within healthcare services.

When answering this question, focus on your passion for healthcare and how the role aligns with your career goals. Mention your desire to contribute to patient care and the importance of accurate billing in a dental practice.

To respond effectively, share specific examples from your past roles highlighting your understanding of insurance verification, compliance checking, and the steps you take to ensure accuracy before claims submission.

Discuss your method for investigating discrepancies, such as reviewing medical records and collaborating with team members to resolve issues. Emphasize the importance of accuracy in ensuring proper billing procedures.

Outline your proficiency with relevant software such as Microsoft Office Suite, dental insurance management tools, and billing software. Mention any specific systems you've used and how they have assisted you in previous roles.

Share your knowledge of billing standards and regulations, and explain the procedures you follow to stay compliant. You can mention how you regularly audit documents and work collaboratively with providers to resolve any issues.

Use this opportunity to narrate a specific situation that illustrates your attention to detail. Describe the error, your process in identifying and correcting it, and how it impacted patient care or the overall billing process positively.

Explain your approach to task prioritization, perhaps by using lists or digital tools, and share how you handle competing deadlines while ensuring that all claims are processed accurately and timely.

Reflect on specific challenges in the role such as dealing with complex insurance claims or the fast-paced environment. Discuss how your skills and prior experiences have prepared you to overcome these challenges.

Provide an example of a team project where you played a role in achieving a common goal related to healthcare or billing. Highlight your communication skills and your commitment to working collaboratively.

Emphasize your customer service skills, empathy, and communication strategies. Discuss how you would listen to their concerns, offer solutions, and ensure follow-up to resolve the issue satisfactorily.