Claims Operations Lead

Zenith American Solutions, Inc.; San Francisco (CA); On-site; USD 81,000 - 99,000; Full time

Job summary

Zenith American Solutions, Inc. seeks a Supervisor, Claims in San Francisco to lead a claims team within a regulated, client-focused environment.

The role requires ensuring adherence to company guidelines, client needs, and regulatory requirements while providing daily supervision and staff development. The ideal candidate has extensive experience processing complex health and welfare claims, strong leadership, and the ability to optimize workflows.

Qualifications

• High school diploma or GED.
• Four years of experience processing complex health and welfare claims in a third-party administrator.
• One year of experience in a lead or supervisory role.
• Advanced knowledge of benefits claims adjudication principles and ICD-10 and CPT-4 codes.
• Strong communication and organizational skills; ability to manage multiple priorities.

Responsibilities

• Provide daily leadership and supervision to staff.
• Assign, monitor, and ensure quality and production standards.
• Develop staff through performance management and training.
• Maintain knowledge of plans and ensure processing compliance.
• Optimize workflows and staff allocation for efficiency.
• Handle complex or large-dollar claims and third-party recovery investigations.
• Prepare documents for external audits.
• Develop departmental SOPs.
• Perform other duties as assigned.

Skills

Leadership

Claims processing

Communication

Problem solving

Microsoft Office

Regulatory compliance

Team supervision

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Zenith American Solutions, Inc. seeks a Supervisor, Claims in San Francisco to lead a claims team within a regulated, client-focused environment.

The role requires ensuring adherence to company guidelines, client needs, and regulatory requirements while providing daily supervision and staff development. The ideal candidate has extensive experience processing complex health and welfare claims, strong leadership, and the ability to optimize workflows.