![Zenith American](https://media.trabajo.org/img/noimg.jpg)
Claims Processor Specialist
2 months ago
**Title**: Claims Processor Specialist **Department**: Claims
**Bargaining Unit**: OPEIU 29 **Grade**:20
**Position Type**: Non-Exempt **Hours per Week**: 40
**Date Open**: 04/24/2024
**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**:
We have other current jobs related to this field that you can find below
-
Claims Processor
2 months ago
San Francisco, United States Zenith American Full timeTitle: Claims Processor 1 Department: Claims Bargaining Unit: 153 Grade: 16 Position Type: Non-Exempt Hours per Week: 40 Position Summary 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. "Has minimum...
-
Claims Processor
2 months ago
San Francisco, United States Zenith American Full timeJob DescriptionJob DescriptionTitle: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16Position Type: Non-Exempt Hours per Week: 40Position SummaryThe 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...
-
Claims Processor
2 months ago
San Francisco, United States Zenith American Full timeJob DescriptionJob DescriptionTitle: Claims Processor 1 Department: Claims Bargaining Unit: OPEIU 29 Grade: 16Position Type: Non-Exempt Hours per Week: 40Position SummaryThe 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...
-
Claims Processor LPO
3 weeks ago
San Antonio, United States Southwest Business Corp Full timeSWBC is seeking a talented individual to perform functions associated with processing claim documents and inquiries related to insurance claims for multiple lines of business and more complex coverage types of CPI and GAP, including filing and tracking. Why you'll love this role:Looking for a great opportunity to expand your career path and have the...
-
Remote Field Based Property Claims Specialist
4 weeks ago
San Francisco, CA, United States State Farm Mutual Automobile Insurance Company Full timeClaim Specialist - Property Field Inspection Regular Full Time # Claims and Investigation An annual bonus based on individual and enterprise performance Industry leading Tuition Assistance Programs Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we are at State Farm. This position is for...
-
Remote Field Based Property Claims Specialist
2 weeks ago
San Francisco, CA, United States State Farm Mutual Automobile Insurance Company Full timeClaim Specialist - Property Field Inspection Regular Full Time # Claims and Investigation An annual bonus based on individual and enterprise performance potentially up to 15% of annual salary Industry leading Tuition Assistance Programs Being good neighbors – helping people, investing in our communities, and making the world a better place – is who we...
-
Claims Quality Specialist
4 weeks ago
San Leandro, United States Community Health Center Network Full timeOrganizational DescriptionThe Community Health Center Network (CHCN), a sister organization to the Alameda Health Consortium, comprises eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health and Anthem Blue Cross. To help our health...
-
Claims Quality Specialist
4 weeks ago
San Leandro, United States Community Health Center Network Full timeOrganizational DescriptionThe Community Health Center Network (CHCN), a sister organization to the Alameda Health Consortium, comprises eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health and Anthem Blue Cross. To help our health...
-
Medical Claims Specialist
3 weeks ago
San Antonio, United States PrideStaff Full timeClaims Specialist Medical Device MFG IH10/DeZavala Area Mon- Fri 8-5 $ 16+ per hour Place phone calls to insurance providers to follow up on insurance claims.Previous experience with medical insurance claims a must. Compensation / Pay Rate (Up to): $16.00 - $18.00 Per Hour
-
Medical Billing and Coding Specialist
2 months ago
San Francisco, United States Zenith American Full timeJob DescriptionJob DescriptionTitle: Claims Processor 1 Department: Claims Bargaining Unit: 153 Grade: 16Position Type: Non-Exempt Hours per Week: 40Position SummaryThe 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...
-
Senior Liability Claims Specialist
2 weeks ago
San Diego, United States CorVel Corporation Full timeCorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients. The position is premise liability focused, with premise...
-
Claims Quality Specialist
1 month ago
San Leandro, United States Community Health Center Network Inc Full timeJob DescriptionJob DescriptionOrganizational DescriptionThe Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health. In...
-
Senior Liability Claims Specialist
2 weeks ago
San Diego, United States CorVel Enterprise Comp, Inc. Full timeJob DescriptionJob DescriptionCorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients.The position is premise liability...
-
Senior Liability Claims Specialist
2 weeks ago
San Diego, United States CorVel Enterprise Comp, Inc. Full timeJob DescriptionJob DescriptionCorVel in is seeking a Senior Liability Claims Specialist. The Senior Liability Claims Specialist manages within company best practices complex and non-complex Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients.The position is premise liability...
-
Claims Examiner II
1 month ago
San Antonio, United States 052 SLIC Insurance Agency, LLC Full timeSWBC is seeking a talented individual to review and evaluate incoming claims for payment or denial and acts as a liaison for the carrier and the financial institution. This role allows you to help those who are dealing with difficult circumstances in their lives. Your help gives them a sense of relief in times of need. You will also have a team who is...
-
Claims Examiner II
1 month ago
San Antonio, United States SWBC Full timeSWBC is seeking a talented individual to review and evaluate incoming claims for payment or denial and acts as a liaison for the carrier and the financial institution. Why you'll love this role: This role allows you to help those who are dealing with difficult circumstances in their lives. Your help gives them a sense of relief in times of need. You will...
-
Claims Specialist
2 months ago
San Diego, United States Safety Management Services Inc Full timeJob Type Full-time Description POSITION SUMMARY Under direct supervision, performs basic claim handling functions to include data entry, bill payment, ordering various reports from outside parties, preparing and filing various required forms. Interacts with clients and outside vendors for various reasons including but not limited to gathering data and...
-
Workers Compensation Claims Specialist, CRS
3 weeks ago
San Diego, United States Holmes Murphy & Associates Full timeHolmes Murphy has always believed that investing in our employees, the spaces in which they work, and the environment that we provide are all critical to our culture, purpose, and the services we offer. After all, we know that employees who feel appreciated and recognized for their hard work and dedication results in employees who feel immensely invested in...
-
Payroll Specialist
2 months ago
San Francisco, United States Addison Group Full timeTitle: Payroll SpecialistLocation: RemotePay Rate: $55/hrInternal ID: 552556 Addison Group is seeking a payroll specialist for a privately held company that provides a cloud-based payroll, benefits, and HR management software for business based in the US. This open role focuses more so on case management versus traditional payroll processing, acting as a...
-
Loss Mitigation Specialist, Claims
3 weeks ago
San Diego, United States Guild Mortgage Full timeGuild Mortgage Company , closing loans and opening doors since 1960. As a mortgage banking firm we are dedicated to serving the home owner/buyer. Our goal is to provide affordable home financing for our customers, utilizing the best terms available while providing a level of professionalism and service unsurpassed in the lending industry. Position...