Senior Claims Processor

Title: Senior Claims Processor Department: Claims

Bargaining Unit: UFCW 21 Grade: 8

Position Type: Non-Exempt Hours per Week: 40

Date Open: 05/30/2024

Position Summary

The Claims Processor, Sr provides customer service and processes health and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in the payment of claims and other job functions
• Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, time-loss, or disability.
• May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries.
• Processes voids, stop payments, and refunds to adjust claims that have been processed incorrectly.
• Conducts research to resolve issues or complicated claims; composes detailed and customized correspondence as necessary.
• Performs pre-authorizations, file audits, and researches and resolves appeals as applicable.
• May work with attorneys on subrogation and worker's compensation claims.
• Acts as a resource to department by assisting teammates with questions and difficult claims.
• Performs other duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Three years of experience processing health and welfare claims.
• Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology and ICD-10 and CPT-4 codes.
• Thorough knowledge of claims operations to include payment of claims, interpretation of contracts, communication of benefits, etc.
• 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 environment with shifting priorities and to 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.

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic Claims Processor, Sr. 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 45 offices, and 1,500 professional staff nationwide. Zenith American Solutions was founded in 1944, and grown over the course of many decades by merging the unsurpassed experience of 17 national and regional Third Party Administrators. By combining resources, best practices and scale, Zenith American Solutions 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 savings 401(k) plan with company match, 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.