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Zenith American Solutions, Inc. · 2 months ago

Claims QR Technician

Tampa, FL

Full-time

Onsite

Senior Level

5+ years exp

Zenith American Solutions is the largest independent Third Party Administrator in the United States, and they are seeking a Claims Quality Review Technician. This role is responsible for performing detailed quality reviews of processed claims to ensure accuracy and compliance with eligibility rules, benefits paid, client requirements, and applicable legislative and regulatory guidelines.

AssociationInformation Technology

Responsibilities

Reviews processed claims, including hospital, medical, dental, vision, prescription and time loss to confirm accuracy and appropriate adjudication of benefits

Identify and document quality trends, provide feedback, and assist management in monitoring processing performance against established standards

Reviews and interprets new benefit plans and/or benefit plan changes, develops resource materials and acts as a resource for staff

Conducts training for new and current employees on claims adjudication, contract language, benefit interpretation, claims QR process and departmental procedures

Collaborate with internal partners to resolve complex claim issues and support continuous improvement

Performs other duties as assigned

Qualification

Claims processingQuality reviewCPT codingICD-10 codingMicrosoft ExcelAnalytical skillsTraining skillsRegulatory knowledgeProblem-solvingAttention to detail

Required

High school diploma or GED required

5+ years of related experience, including claims processing, training and/or claims quality review

Strong understanding of claims processing guidelines and benefit plan structures, and regulatory requirements

Demonstrated analytical, research, and problem-solving abilities with strong attention to detail

Working knowledge of CPT, HCPC and ICD-10 coding

Proficiency in Microsoft Word, Excel and Outlook

Preferred

Experience working in a Taft-Hartley environment

Prior quality assurance or audit -focused experience

Familiarity with automated claims platforms

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