Medical Claims Adjustor

American Benefit Plan Administrators, Inc.; Maryland; On-site; USD 22,000 - 31,000; Full time

Benefits offered by this job

Health insurance

Vision benefits

Dental coverage

401(k) retirement plan

Paid time off

Job summary

Zenith American Solutions is seeking a Medical Claims Adjustor in Maryland to process routine health and welfare claims and support customer inquiries. You will apply plan guidelines, use ICD-10 and CPT-4 coding, and protect PHI/PII while maintaining accuracy and compliance.

The role emphasizes attention to detail, integrity, and a team-oriented approach within a fast-paced environment. Flexible, supportive benefits and a strong service culture are highlighted.

Qualifications

• 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.
• Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.

Responsibilities

• Process routine health and welfare claims.
• Provide customer service by sending out pending letters.
• Maintain current knowledge of assigned plans and apply it to claims payment.
• Handle confidential information with discretion.

Skills

Communication

Benefits interpretation

Team player

Integrity

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Position SummaryThe Medical Claims Adjustor 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, or Workers’ Compensation.May provide customer service by sending out pending letters.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.Working Conditions/Physical EffortProlonged periods of sitting at a desk and working on a computer.Must be able to lift up to 15 pounds at times.Disability AccommodationConsistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions 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] , and we would be happy to assist you.Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.Compensation: $19.00/hrZenith 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!