Claims Processor

Zenith-American; Tualatin (OR); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Paid time off

Career growth

Job summary

Zenith American Solutions is seeking a detail-oriented Claims Processor to support health and welfare accounts. You will review plans, process routine claims, and deliver courteous, accurate customer service while safeguarding PHI/PII.

This non-exempt role requires a high school diploma, 6 months of claims experience, and solid knowledge of benefits terminology and coding. You’ll work with a team in a fast-paced environment and contribute to compliant, timely payments.

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 including ICD-10/CPT-4 codes.
• Strong work ethic and team player mentality.
• Integrity and commitment to customer satisfaction.
• Clear verbal and written communication skills.
• Ability to read, analyze, and interpret business materials, procedures, plans and regulations.
• Ability to perform calculations and handle confidential matters discreetly.
• Proficiency with Microsoft Office tools.

Responsibilities

• Maintains knowledge of assigned Plan(s) and applies it to claim payments.
• Processes routine claims across medical, dental, vision, prescription, life/AD&D, workers' comp or disability.
• Responds to inquiries via phone, written, electronic, or in-person.
• Performs other duties as assigned.

Skills

Customer service

Claims processing

Communication

Attention to detail

Regulatory compliance

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. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

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 and ICD-10 and CPT-4 codes.
• Possesses a 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 environment with shifting priorities and to 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.

*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.

Company Overview

Zenith American Solutions Real People. Real Solutions. National Reach. Local Expertise. We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before. We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect.

If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American! We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more! At Zenith American Solutions, we take immense pride in fostering a positive, respectful, and supportive work environment that provides challenging opportunities while supporting a healthy work/ life balance.

Our organizational culture is founded on principles of integrity, honesty and respect for all stakeholders, including our employees, clients, and business partners. With a low employee turnover rate and a high rate of internal promotions and transfers, the Zenith team is proud to be a part of an 80-year legacy of excellence. Our employees embody a spirit of integrity, take immense pride in their work, and are enthusiastic about referring others to join our team.