Job Details

Claims Processor

Position Summary: The Claims Processor provides customer service and processes routine health, and welfare claims on assigned accounts according to plan guidelines and adhering to Company policies and regulatory requirements. This role requires the minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) as defined by the job description and role. Location: On-site - San Francisco, California 94104 Compensation: $27.00 per hour Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits, and a 401k plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Key Duties and Responsibilities:

• Maintain current knowledge of assigned Plan(s) and effectively apply that knowledge in the payment of claims.
• Process routine claims, which may include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability.
• Provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries.
• Review and evaluate insurance claims for validity and completeness.
• Verify insurance coverage and ascertain the degree of the company's liability.
• Communicate with claimants to obtain necessary information and inform them about the claim process.
• Coordinate with insurance adjusters, agents, and investigators to obtain additional information and clarification.
• Make decisions on claim payouts by verifying the claim and determining the insurance policy coverage.
• Process claims payments and send them out to the appropriate party.
• Compile reports on claims processed for use by the insurance company.
• Keep claim files organized and updated, documenting all actions and decisions.
• Stay updated with changes in the insurance industry and in the policies of the company.
• Perform other duties as assigned.

Minimum Qualifications:

• High school diploma or GED.
• Six months of experience processing health and welfare claims.
• Basic knowledge of benefits claims adjudication principles and procedures, medical and/or dental terminology, and ICD-10 and CPT-4 codes.
• 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.
• Ability 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 as a third-party administrator.

Pay Details: $25.00 to $27.00 per hour

Search managed by: Jason Timothy

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled Military connected talent encouraged to apply To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

• The California Fair Chance Act
• Los Angeles City Fair Chance Ordinance
• Los Angeles County Fair Chance Ordinance for Employers
• San Francisco Fair Chance Ordinance

Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Military connected talent encouraged to apply

Ref: US_EN_27_842873_3108293