Claims Specialist

Choicehcs; Vacaville (CA); Hybrid; USD 80,000 - 100,000; Full time

Job summary

A healthcare service company in Vacaville is seeking a Claims Specialist to ensure the accuracy of patients’ accounts and compliance with billing standards. This entry-level, full-time hybrid position requires collaboration with providers and attention to billing errors. Candidates should have strong customer service skills and a Denti-Cal dental background. Competitive pay at $22-$24 per hour based on experience.

Benefits

Care for your wellbeing and work-life balance

Professional and personal growth opportunities

Experienced leadership support

Fun and supportive team dynamic

Comprehensive benefit package

Qualifications

• Preferred but not mandatory Associate degree (A.A.) or equivalent from a two-year college or technical school.
• Minimum of high school diploma or equivalent.

Responsibilities

• Verify dental insurance coverage and benefits are correct.
• Monitor healthcare documents to ensure compliance before submission.
• Collaborate with providers for accurate information.
• Review treatment plans and chart notes.
• Respond to the OPs team & RCM Billing team in a timely manner.

Skills

Customer service experience

Strong Denti-Cal dental background

Proficiency with Microsoft Excel

Proficiency with Microsoft Word

Proficiency with Microsoft Outlook

Proficiency with Teams

Proficiency with OneNote

Proficiency with Open Dental

Proficiency with NICE

Proficiency with NexHealth

Education

High school diploma or equivalent

Associate degree (A.A.) from a two-year college

Job description

Claims Specialist

Company: CHOICE Healthcare Services

Location: Vacaville, CA

Employment Type: Full-time (Hybrid)

Seniority Level: Entry Level

Summary

The Claims Specialist verifies the accuracy and completeness of patients’ accounts within the dental practice, ensuring compliance with billing standards and identifying potential errors and fraud before claims are submitted to insurance companies. This full‑time hybrid position requires working from the Vacaville office a few days a week and from home the remaining days. Shift hours are 7:00 am–4:00 pm.

Benefits

• Care for your wellbeing and work‑life balance
• Professional and personal growth opportunities
• Experienced leadership support
• Fun and supportive team dynamic with events and celebrations
• Comprehensive benefit package

Pay Range

$22.00–$24.00 per hour (based on experience)

Essential Duties and Responsibilities

• Verify dental insurance coverage and benefits are correct.
• Monitor healthcare documents and dental documents to ensure compliance before submitting to insurance companies.
• Check medical records for appropriate criteria and provide the proper documentation.
• Collaborate with providers to ensure all information is accurate.
• Review requests for services, research and gather further information when necessary, perform an information audit, and evaluate procedures for approval.
• Record, analyze, and report data elements that could help improve the quality of care of a patient.
• Review treatment plans and chart notes.
• Able to read dental x‑rays for justification of dental care.
• Pre‑auditing of charts.
• Post‑auditing of charts.
• Respond via Teams chat/email to the OPs team & RCM Billing team in a timely manner.
• Ensure billing errors are flagged and corrected.
• Create claims.

Education and/or Experience and Qualifications

• Preferred but not mandatory Associate degree (A.A.) or equivalent from a two‑year college or technical school; or six months to one year related experience and/or training; or an equivalent combination of education and experience.
• Minimum of high school diploma or equivalent.

Experience

• Customer service experience.
• Strong Denti‑Cal dental background – a must.
• Preferred one year previous experience in a dental office or role that included direct patient contact and prior dental insurance processing experience.
• Dental healthcare experience in a dental office setting.
• Proficiency with Microsoft Excel, Word, Outlook, Teams, OneNote, Open Dental, NICE, NexHealth.