Claims Processor 3

Zenith American Solutions•San Francisco, CA

2d•Onsite

About The Position

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. 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.

Requirements

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.

Responsibilities

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.