Claims Processor

Zenith American Solutions, Inc.; Portland (OR); On-site; USD 42,000 - 54,000; Full time

Job summary

Zenith American Solutions, Inc. is seeking a Claims Processor in Portland, Oregon to provide customer service and process routine health and welfare claims in accordance with plan guidelines and company policies.

The role requires attention to detail, knowledge of benefits claims adjudication, and the ability to manage shifting priorities in a 40-hour, non-exempt position within a collaborative Claims department.

Qualifications

• High school diploma or GED required.
• Six months of experience processing health and welfare claims.
• Basic knowledge of benefits claims adjudication principles and medical/dental terminology (ICD-10, CPT-4).
• Strong work ethic and ability to work in a team.
• Ability to communicate clearly both verbally and in writing.
• Ability to read, analyze, and interpret general business materials, plans and regulations.
• Ability to calculate figures such as discounts and percentages.

Responsibilities

• Maintains knowledge of assigned plans and applies knowledge to claim payments.
• Processes routine health and welfare claims (medical, dental, vision, prescription, etc.).
• Responds to customer inquiries via telephone, written, electronic, or in-person channels.
• Performs other duties as assigned.

Skills

Customer service

Communication

Team player

Microsoft Office

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Title: Claims Processor

Department: Claims

Bargaining Unit: UFCW 555

Grade: 3

Position Type: Non-Exempt

Hours per Week: 40

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.

Key Duties and Responsibilities

• Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims.
• Processes routine claims which could include medical, dental, vision, prescription, death, Life and AD&D, Workers' Compensation, or disability.
• May provide customer service by responding to and documenting telephone, written, electronic, or in‑person inquiries.
• Performs 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, and medical and/or dental terminology, 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.
• Must be able 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 in a third‑party administrator.