Job Details

Job Title

Claims Processor Specialist

Seniority Level

Mid-Senior level

Employment Type

Full-time

Responsibilities

• Independently processes medical, dental and/or hospital claims, including complex claims.
• 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.
• Makes current knowledge of assigned Plan(s) and effectively applies knowledge in payment of claims, customer service and all other job functions.
• Handles special duties and higher level functions (e.g., 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 backup on all other accounts.
• Consistently meets established performance standards and demonstrates excellent attendance and punctuality.
• Performs other related duties and special projects as assigned.

Working Conditions / Physical Effort

• Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements.
• May be subject to interruptions.
• May be required to lift a maximum of 25 lbs.
• Must have flexible work schedule when workflow requires.
• Must meet established attendance and punctuality guidelines.

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.
• Strong work ethic and ability to work effectively in a team environment.
• Highly developed sense of integrity and commitment to customer satisfaction.
• 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 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.
• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, Zenith American Solutions provides reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at ...@zenith-american.com.

Compensation

$37.28/hr

Company Overview

Zenith American Solutions is the largest independent third?party administrator in the United States, operating over 44 offices nationwide. Our company offers a comprehensive benefits program that includes health, vision and dental coverage, a 401(k) plan with company match, paid time off (PTO) and many opportunities for growth. We pride ourselves on hiring top talent who share our dedication to high?quality work, exceptional service and mutual respect. If you are interested in working in an environment where peopleemployees and clientsreally matter, consider bringing your talents to Zenith American Solutions.