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Zenith American Solutions, Inc. · 5 months ago

Claims Processor Specialist

San Fran ILWU

Full-time

Hybrid

Mid Level

$37.28/hr - $37.28/hr

3+ years exp

Zenith American Solutions, Inc. is the largest independent Third Party Administrator in the United States, operating over 44 offices nationwide. They are seeking a Claims Processor Specialist to independently process medical, dental, and hospital claims, provide customer service, and act as a lead resource for other claims processing positions.

AssociationInformation Technology

Responsibilities

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

Qualification

Claims processingMedical terminologyICD-9CPT-4 codesCustomer serviceOrganizational skillsMathematical aptitudeTyping 35 WPMMS WordExcelBusiness writingAttention to detailEffective communicationTeamwork

Required

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

Benefits

Health, vision, and dental coverage

A retirement savings 401(k) plan with company match

Paid time off (PTO)

Great opportunities for growth

Much, much more

Company

Zenith American Solutions, Inc.

Zenith American Solutions (“Zenith”) stands out as a top provider of third-party administration services specifically designed for Taft-Hartley trust funds in the U.S.

Founded in 1944

Mokena, Illinois, USA

1001-5000 employees