Claims Processor 3

Zenith American Solutions; San Francisco (CA); On-site; USD 309,000 - 440,000; Full time

Benefits offered by this job

Health coverage

Vision coverage

Dental coverage

401(k) with company match

Paid time off

Job summary

Zenith American Solutions is seeking a Claims Processor 3 in the United States. This role handles independently processing all types of health claims for assigned plans and supports customer service for providers and members.

You will generate correspondence, stay current with plan specifics, and assist others to minimize backlog while performing related duties and special projects as needed.

Qualifications

• High school diploma or GED with two years of experience processing health/dental claims.
• Knowledge of benefits claims processing, adjudication principles, medical/dental terminology, ICD-9 and CPT-4 codes.
• Typing speed of 45 WPM.
• Ability to read and interpret documents such as procedure manuals and health plans.
• Ability to write routine reports and correspondence and present information clearly.

Responsibilities

• Process all types of health claims independently for assigned plans.
• Provide customer service for providers and members as needed.
• Generate correspondence and form letters.
• Maintain current knowledge of assigned plans and apply it to claim payments.
• Assist other processors with claims to minimize backlog.
• Perform other related duties and special projects as assigned.

Skills

Typing 45 WPM

Reading and interpreting documents

Effective communication

Problem solving

Education

High school diploma or GED

Job description

Title: Claims Processor 3 Department: Claims
Union: OPEIU 29 Grade: 18

Position Summary:

Responsible for independently processing all types of health claims on an assigned Plan(s), and for assuming primary or back-up customer service responsibilities as necessary.

General Duties:

• Independently process all types of health claims in accordance with assigned Plan(s).
• Perform customer service responsibilities for providers and members as needed.
• Generate correspondence and form letters.
• Maintain current knowledge of assigned Plan(s) and effectively apply this knowledge in the payment of claims.
• Assist other processors with claims as needed to minimize backlog.
• Perform other related duties and special projects as assigned.

Minimum Qualifications:

• High school diploma or general education degree (GED); two years related experience processing all types of group health and/or dental benefit claims.
• Knowledge of all aspects of benefits claims processing and basic claims adjudication principles and procedures, medical and/or dental terminology, and ICD-9 and CPT-4 codes.
• Ability to type 45 WPM.
• Ability to read and interpret documents such as procedure manuals and health plans.
• Write routine reports and correspondence. Ability to speak effectively and present information in one-on-one and small group situations to customers, clients and other employees of the organization.
• Calculate figures and amounts such as discounts, interest, proportions, and percentages.
• Ability to solve practical problems.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Ability to meet production and quality goals on a consistent basis.

Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.

Compensation: $27.81/hr

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.

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!