Senior Claims Processor

2 weeks ago


Oakland, California, United States Zenith American Full time
Job Summary

Zenith American Solutions is seeking a highly skilled and detail-oriented Claims Processor, Sr. to join our team. As a key member of our claims team, you will be responsible for processing health and welfare claims in accordance with plan guidelines and company policies.

Key Responsibilities
  • Process routine claims, including medical, dental, vision, prescription, death, life, and AD&D claims.
  • Provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries.
  • Conduct research to resolve issues or complicated claims and compose detailed and customized correspondence as necessary.
  • Perform pre-authorizations, file audits, and research and resolve appeals as applicable.
  • Work with attorneys on subrogation and worker's compensation claims.
  • Act as a resource to the department by assisting teammates with questions and difficult claims.
Requirements
  • 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 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.

Zenith American Solutions is a leading provider of third-party administration services, with a strong commitment to customer satisfaction and employee development. We offer a comprehensive benefits package, including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), and opportunities for growth and professional development.



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