Claims Processor

About the Role

The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. This role involves minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII).

Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims.
• Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability.
• May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries.
• Performs other duties as assigned.

Requirements

• High school diploma or GED.
• Six months of experience processing health and welfare claims.
• Basic knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
• Possesses a strong work ethic and team player mentality.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans, and regulations.
• Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages.
• Must be able to work in an environment with shifting priorities and handle a wide variety of activities and confidential matters with discretion.
• Computer proficiency including Microsoft Office tools and applications.

Preferred Qualifications

• Experience working in a third-party administrator.

About the Company

Zenith American Solutions is the largest independent Third Party Administrator in the United States, operating over 44 offices nationwide. Formed in 2011 through a merger between Zenith Administrators and American Benefit Plan Administrators, the company has been in business since 1944. We focus on hiring talented individuals who share our dedication to high-quality work, exceptional service, and mutual respect.

Benefits

• Health, vision, and dental coverage.
• Retirement savings 401(k) plan with company match.
• Paid time off (PTO).
• Opportunities for growth.

Hours per Week: 40