Claims Processor

Zenith American Solutions•Pittsburgh, PA

About The Position

The Claims Processor provides customer service and processes routine health and welfare claims on assigned accounts in accordance with plan guidelines, Company policies, and regulatory requirements. The role has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) based on the job description and role. The position requires maintaining current knowledge of assigned plans and applying that knowledge to claim payments. Claims may include medical, dental, vision, prescription, death, Life and AD&D, Workers’ Compensation, or disability claims. The processor may also respond to and document inquiries by telephone, in writing, electronically, or in person, and performs other duties as assigned. The work involves prolonged periods of sitting at a desk and working on a computer, with occasional lifting of up to 15 pounds. Zenith American Solutions states that it provides reasonable accommodation to qualified applicants and employees with disabilities, consistent with applicable law.

Requirements

High school diploma or GED.
Six months of experience processing health and welfare claims.
Basic knowledge of benefits claims adjudication principles and procedures, medical and/or dental terminology, and ICD-10 and CPT-4 codes.
Strong work ethic and team-player mentality.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, 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.
Ability 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.

Nice To Haves

Experience working in a third-party administrator.

Responsibilities

Maintain current knowledge of assigned plans and apply that knowledge when paying claims.
Process routine claims, which may 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.
Perform other duties as assigned.