Claims Examiner

About First Choice Health

First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys. At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping their members healthy.

Our purpose, values & culture

Uniting providers, employers, and individuals, we deliver sustainable solutions that elevate the health and care of our communities.

Care · Transparent · Collaborate · Relentless · Innovate

We strive to uphold the above values and take steps to cultivate our culture through each one. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life. At First Choice Health, we believe that a culture that fosters belonging—one that accepts employees for who they are, nurtures creative thinking, and appreciates different perspectives—drives our success. By cultivating an environment where every voice is valued, we empower our employees to bring their best selves to work, enabling us to serve our clients and communities more effectively.

Responsibilities

• Oversee and ensure timely and accurate claims adjudication for all assigned clients, including data entry, dental, professional, and/or institutional claims.
• Accurately process EDI Errors.
• Process Institutional, Professional, and Dental claims.
• Review, research, and resolve claims in accordance with contracts and policies using reference materials and online tools.
• Consistently maintain department minimum productivity and quality standards for adjudicating claims while meeting established accuracy guidelines.
• Comply with strict privacy, integrity, confidentiality, availability, and maintenance of Protected Health Information.
• Provide feedback to the unit Manager regarding plan benefits, Benefit Quoting Tool (BQT), and system issues.
• Process all levels of claims procedures including Action Requests, Correspondence, Audit and Quality (AQ) work items, and claim adjustments.
• Complete other projects as assigned.

Qualifications

• High School Diploma or equivalent.
• Basic computer skills, including word processing, Windows operating system, and Google Workspace experience (preferred).
• 1–2 years healthcare industry experience.
• CPT, ICD-10, and HCPCS proficiency.

Physical requirements

• Sight within normal ranges, with or without corrective lenses.
• Finger dexterity.
• Ability to be stationary for long periods of time.
• Ability to lift 10 to 15 pounds.

Access to PHI

• Routine & re-occurring access to all forms of PHI – The duties require regular and unrestricted contact with PHI.
• Routine and limited, not requiring manager approval – The duties require routine contact with a limited set of PHI (e.g., claims adjudication).
• Restricted and limited to manager approval on an as-needed basis – Access is flexible and limited to a need-to-know basis predetermined by the manager/supervisor depending on the nature of the task.
• Subject to incidental PHI disclosure – The position will at times come in contact with PHI that cannot be prevented, is limited in nature, and occurs as a result of another permitted use or disclosure (e.g., proximity to areas where PHI is accessed or discussed).

Benefits

• Health & Insurance: Medical (HSA and PPO plans) and Vision coverage, Dental plan, employer-provided Life Insurance, and Short- & Long-Term Disability coverage.
• Financial & Retirement: Health Savings Account (HSA) with company contributions, Flexible Spending Account (FSA), 401(k) plan with an employer match, and discretionary Profit Sharing.
• Time Off & Development: Paid Time Off (PTO) accrued based on tenure, Paid Holidays (including floating holidays and time for community service), and Tuition Reimbursement for continuing education.
• Support: Employee Assistance Program (EAP) for confidential professional counseling, and a Wellness program with rewards.

Note: Benefits are subject to change with or without notice.