Claims Processor Specialist

4 weeks ago

Alameda, United States Zenith American Full time
Job DescriptionJob Description

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

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