Claims Processor 1

Zenith American Solutions, Inc.; San Francisco (CA); On-site; USD 29,265 - 41,681; Full time

Job summary

Zenith American Solutions, Inc. is seeking a Claims Processor 1 to provide customer service and support in processing routine health and welfare claims. This role requires maintaining knowledge of assigned plans and effective communication with customers.

The ideal candidate will possess a high school diploma or GED and at least six months of claims processing experience. The position offers a rate of $25.75 per hour and involves mainly desk work with some physical requirements.

Qualifications

• Six months of experience processing health and welfare claims.
• Basic knowledge of benefits claims adjudication principles.
• Ability to work in a fast-paced environment with shifting priorities.

Responsibilities

• Provide customer service and process routine claims according to guidelines.
• Maintain knowledge of assigned plan(s) for claims payment.
• Respond to inquiries and document customer interactions.

Skills

Customer service

Claims processing experience

Communication skills

Computer proficiency

Education

High school diploma or GED

Tools

Microsoft Office tools

Job description

Title: Claims Processor 1

Department: Claims

Union: OPEIU 29

Grade: 16

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 claims.
• 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 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.

Working Conditions / Physical Effort

Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, Zenith American Solutions policy is to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at [e-mail].

Compensation

Salary: $25.75 per hour.