Claims Processor

Zenith American Solutions•Pittsburgh, PA

About The Position

The Claims Processor provides customer service and processes routine health and welfare claims for assigned accounts in accordance with plan guidelines, company policies, and regulatory requirements. The role has the minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) required by the job description. Claims may include medical, dental, vision, prescription, death, Life and AD&D, Workers’ Compensation, or disability claims. The position may also respond to and document inquiries by telephone, in writing, electronically, or in person. Other duties may be assigned. Duties and responsibilities may change at any time with or without notice.

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.
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 amid 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 health and welfare claims, which may include medical, dental, vision, prescription, death, Life and AD&D, Workers’ Compensation, or disability claims.
Respond to and document customer inquiries by telephone, in writing, electronically, or in person, as needed.
Perform other duties as assigned.