Current jobs related to Claims Processor Specialist - Alameda - Zenith American
-
Claims Processor II
2 months ago
Alameda, United States Allameda Alliance for Health Full timePRINCIPAL RESPONSIBILITIES: Under the direct supervision of the Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is responsible for the accurate review, entry and processing of all claims received for payment by AAH. Principal responsibilities include: Research claims for completion and...
-
Compliance and Operations Specialist
2 weeks ago
Alameda, California, United States Abbott Laboratories company Full timeAbout the RoleAbbott Laboratories, a leading global healthcare company, is seeking a highly skilled and experienced Senior Marketing Operations Specialist to join its team. As a key member of the Global Marketing Operations team, this individual will play a pivotal role in ensuring compliance and operational efficiency within the company's Global Marketing...
-
Senior Marketing Operations Specialist
1 week ago
Alameda, California, United States Abbott Laboratories Full timeAbout Abbott LaboratoriesAbbott Laboratories is a leading global healthcare company that provides innovative solutions to help people live more fully at all stages of life. Our diverse portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals, and branded...
-
Sales Engineering Specialist
3 weeks ago
Alameda, California, United States Air Treatment Full timeJob TypeFull-timePosition OverviewAt Air Treatment Corporation, we foster a vibrant and collaborative workplace. Our commitment to delivering exceptional customer service drives us to build a cohesive team that consistently surpasses expectations. We prioritize the professional development of our employees and offer numerous opportunities for internal...
-
Member Support Representative I
3 weeks ago
Alameda, California, United States Alamedaalliance Full timeOverviewThe Customer Care Specialist I serves as the initial point of contact for our members, addressing both routine and intricate inquiries with the objective of providing exceptional service. This role involves managing a substantial volume of incoming and outgoing communications promptly. It is essential to respond to all member inquiries via various...
-
Contract Specialist | Oakland, Ca
3 days ago
Alameda, United States LHH Recruitment Solutions Full timeJob DescriptionJob DescriptionJob Posting: Contract Specialist II (Onsite in Oakland) Must come from Construction Industry Pay Range: $55-60 per hourSchedule: Every other Friday offContract: 3-6 monthsBilingual skills in ASL, Mandarin, Cantonese, Vietnamese and/or Spanish are a plus. Position Overview:We are seeking a Contract Specialist II, a...
-
Regulatory Compliance Specialist
3 weeks ago
Alameda, California, United States Abbott Laboratories company Full timeAbout Abbott LaboratoriesAbbott Laboratories is a leading global healthcare organization dedicated to enhancing the quality of life for individuals at every stage of their health journey. Our extensive portfolio includes innovative technologies across diagnostics, medical devices, nutritionals, and branded generic medicines, supported by a workforce of...
-
Member Support Specialist I
3 weeks ago
Alameda, California, United States Alamedaalliance Full timeOverviewAs a Member Services Representative I, you will serve as the initial point of contact for our members, addressing both routine and intricate inquiries with the aim of providing exceptional customer support. Key ResponsibilitiesYour primary duties will include managing a significant volume of inbound and outbound communications promptly. You will...
-
Alameda, California, United States Abbott Full timeAbout the RoleAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160...
-
Alameda, United States Abbott Laboratories Full timeThe OpportunityThis position works out of our Alameda, CA location in the Diabetes Care division where we are focused on helping people with diabetes manage their health with life-changing products that provide accurate data to drive better-informed decisions. We're revolutionizing the way people monitor their glucose levels with our new sensing...
-
Alameda, United States Abbott Laboratories Full timeAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries.The...
-
Regulatory Affairs Specialist
1 month ago
Alameda, United States Abbott Laboratories Full timeAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues serve people in more than 160 countries.About...
-
Member Services Representative I
2 months ago
Alameda, United States Alameda Alliance Full timePRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a...
-
Member Services Representative I
2 months ago
Alameda, United States Alamedaalliance Full timeBrief Description PRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and...
-
Member Services Representative I
4 weeks ago
Alameda, United States Alameda Alliance Full timePRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a...
-
Member Services Representative I
2 months ago
Alameda, United States Alameda Alliance Full timePRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a...
-
Member Services Representative I
2 months ago
Alameda, United States Alameda Alliance Full timePRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a...
-
Member Services Representative I
1 week ago
Alameda, United States Alameda Alliance for Health Full timeDescriptionPRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound...
-
Member Services Representative I
1 week ago
Alameda, United States Alameda Alliance for Health Full timeDescriptionPRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound...
-
Member Services Representative I
7 days ago
Alameda, United States Alameda Alliance for Health Full timeDescriptionPRINCIPAL RESPONSIBILITIES: Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls...
Claims Processor Specialist
4 months ago
Title: Claims Processor Specialist Department: Claims
Bargaining Unit: 853 Grade: 5
Position Type: Non-Exempt Hours per Week: 40
Date Open: 05/22/2024
Position Summary:
Independently processes medical, dental and/or hospital claims, including more difficult or complex claims, provides customer service, and handles special projects and complex functions, including subrogation; acts as a "lead" and resource for other claims processing positions.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
General Duties:
- Processes medical, dental and/or hospital claims; processes complex claims independently.
- Provides customer service by responding to and documenting telephone and/or written inquiries.
- Meets quantity and quality claims processing standards.
- Performs pre-authorizations, audits files, requests check tracers and stop payments, and assists with researching and preparing appeals, as applicable.
- Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in the payment of claims, customer service and all other job functions.
- Handle special duties and higher level, more complex functions (i.e. third party liability/subrogation, Flex, re-insurance, PPO updates, life insurance, etc.) as assigned.
- Acts as a resource or "lead" for all processor positions by answering questions, providing assistance, conducting training, and providing back-up on all other accounts.
- Consistently meets established performance standards and demonstrates excellent attendance and punctuality.
- Performs other related duties and special projects as assigned.
Minimum Qualifications:
- High School Diploma or Equivalent.
- Three years of experience processing all types of group medical, dental and hospital claims; in-depth knowledge of benefits, claims adjudication principles and procedures, medical and/or dental terminology and ICD-9 and CPT-4 codes.
- Excellent organizational skills, attention to detail, and ability to interact effectively with others.
- Effective oral and written communication skills.
- Excellent mathematical aptitude.
- Solid organization skills with strong detail orientation/high degree of accuracy.
- Possess a strong work ethic and the ability to work effectively in a team environment.
- Highly developed sense of integrity and commitment to customer satisfaction.
- Ability to communicate clearly and professionally, both verbally and in writing.
- Ability to type 35 WPM and use a 10-key; proficient PC skills, including MS Word and Excel.
- Ability to perform well under pressure and to juggle many projects simultaneously.
- Excellent business writing skills.
- Ability to read, analyze and interpret general business materials, technical procedures, benefit plans and regulations.
- Able to maintain excellent attendance and punctuality.
Zenith American Solutions
Real People. Real Solutions. National Reach. Local Expertise.
We are currently seeking an experienced Claims Processor Specialist with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.
Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 40 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before
We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement plan, paid time off (PTO), great opportunities for growth, and much, much more
Internals to Apply:
If you meet the minimum qualifications and are interested in applying for the above position, please submit an application.
Job Posted by ApplicantPro
