Claims Processor I

Pacific Administrators (PAI) was founded in 2001 with a mission to provide exceptional Third-Party Administration services to Multi-Employer (Taft-Hartley) Employee Benefit Plan Trust Funds. PAI has been awarded one of Hawaii Business Magazine's Best Places to Work for 2026 and is Hawaii’s Largest Locally Owned & Operated Third-Party Administrator.

About the Role

The Claims Processor I will work under the Claims Department Supervisor to process all medical, hospital, vision, chiropractic and ancillary claims, which includes coordination of benefit and third-party liability claims in accordance with department policies and procedures.

Responsibilities:

• Process Medical claims
• Process Hospital and Ancillary Claims
• Process Vision and Chiropractic Claims
• Send referrals to Managed Care Department
• Send claims to contract negotiator for individual negotiations
• Correct and submit error tickets
• Process Claim Adjustments
• Assist Customer Service Department with customer inquiries
• Assist Department Lead and/or Supervisor with other departmental or Health and Welfare duties
• Be able to maintain error rate and production quotas
• Occasional carrying, loading and transporting of supplies
• Perform other duties as assigned

• Minimum of (2) year work experience or equivalent (combination of education and work)
• Type 45 WPM
• 10-key by Touch
• Computer literate in Word and Excel and other Microsoft applications
• Good organization skills and able to handle multi tasks
• Good analytical skills
• Self-starter and quick learner

• Knowledge of ICD-9, ICD-10, CPT, HCPCS, FORM 1500, and UB04 forms, Medical and Revenue Coding, and Medical Terminology is a plus

• PAI offices are indoors & air-conditioned while conditions may vary at client locations
• Monday to Friday, 8:00 - 4:00 PM or 8:30 AM - 4:30 PM, with a 1-hour unpaid lunch
• The duties assigned will have situations that will require extra time