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Claims Processing Specialist

2 months ago


San Francisco, California, United States Zenith American Full time
Job Overview

Position Title: Claims Processor 1 Department: Claims Management

Bargaining Unit: OPEIU 29 Grade: 16

Employment Type: Non-Exempt Weekly Hours: 40


Position Summary

The Claims Processor plays a crucial role in delivering exceptional customer service while managing the processing of standard health and welfare claims for designated accounts. This role adheres to established plan guidelines and complies with company policies and regulatory standards.

Access to Protected Health Information (PHI) and Personally Identifiable Information (PII) is limited to what is necessary for this role.


Key Responsibilities

  • Maintains up-to-date knowledge of assigned plans and effectively utilizes this knowledge in claims processing.
  • Handles routine claims, which may encompass medical, dental, vision, prescription, life insurance, Workers' Compensation, and disability claims.
  • Provides customer support by addressing and documenting inquiries through various communication channels.
  • Performs additional duties as required.

Minimum Qualifications

  • High school diploma or equivalent.
  • At least six months of experience in processing health and welfare claims.
  • Basic understanding of claims adjudication principles, medical and dental terminology, and familiarity with ICD-10 and CPT-4 coding.
  • Demonstrates a strong work ethic and a collaborative team spirit.
  • Exhibits a high level of integrity and a commitment to customer satisfaction.
  • Possesses clear and professional communication skills, both verbal and written.
  • Ability to read, analyze, and interpret various business documents, technical procedures, and benefit plans.
  • Competent in performing calculations related to discounts, interest, proportions, and percentages.
  • Capable of adapting to a dynamic work environment and managing a range of activities with confidentiality.
  • Proficient in using Microsoft Office and other relevant applications.

Preferred Qualifications

  • Experience in a third-party administration setting.

*This job description is intended to provide a general overview of the position and is not exhaustive of all duties and responsibilities that may be assigned.


About Zenith American Solutions

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

We are seeking a motivated and skilled Claims Processor 1 who is eager to contribute to our mission of excellence in service delivery. Zenith American Solutions stands as the largest independent Third Party Administrator in the United States, with a robust presence across 44 offices nationwide. Our legacy dates back to 1944, and we have grown stronger through the merger of Zenith Administrators and American Benefit Plan Administrators in 2011.

At Zenith American, we believe that our commitment to superior service begins with our employees. We are always on the lookout for talented individuals who share our dedication to quality work and mutual respect. If you are interested in joining a team where both employees and clients are valued, we encourage you to consider a career with us.

We recognize the significance of a comprehensive benefits program for our employees and their families. Our total compensation package includes health, vision, and dental coverage, a 401(k) retirement savings plan with company matching, paid time off (PTO), and numerous opportunities for professional growth.

Internal Applicants:

If you meet the minimum qualifications and wish to apply for this position, please submit your application.

Job Posted by ApplicantPro