Claims Processor

Zenith-American; Tualatin (OR); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Health insurance

401(k) retirement plan

Paid time off

Job summary

Zenith American Solutions is seeking a dedicated Claims Processor to provide customer service and process routine health and welfare claims in accordance with plan guidelines.

The role requires attention to HIPAA/PII data handling, familiarity with ICD-10/CPT-4 codes, and strong integrity. A high school diploma or GED is required, with at least six months of claims experience and proficient computer skills.

Qualifications

• High school diploma or GED required.
• Six months of experience processing health and welfare claims.
• Knowledge of benefits claims adjudication principles and medical/dental terminology.
• Ability to communicate clearly, both verbally and in writing.
• Ability to read, analyze and interpret general business materials and regulations.
• Proficiency with Microsoft Office and general computer skills.

Responsibilities

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

Skills

Communication

Reading & interpreting

Microsoft Office

Discretion & integrity

Team player

Education

High school diploma or GED

Tools

Microsoft Office Suite

Job description

Title: Claims Processor Department: ClaimsBargaining Unit: UFCW 555 Grade: 3Position Type: Non-exempt Hours per Week: 40Position SummaryThe 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 ResponsibilitiesMaintains 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 QualificationsHigh 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 discretionComputer proficiency including Microsoft Office tools and applications.Preferred QualificationsExperience 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.Zenith American SolutionsReal 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!