Customer Service Claims Processor

Zenith American Solutions•San Francisco, CA

1d•$27

About The Position

The Customer Service Claims Processor is focused on providing customer service via call handling to participants, beneficiaries, union locals and providers regarding eligibility, benefits and claims status in conjunction with claims processing as business needs dictate. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Requirements

High School Diploma or GED.
One year of experience working on the Customer Service or Claims teams.
Proficiency with MS Office tools and applications.

Nice To Haves

Proficiency with conference software such as Zoom or Webex.

Responsibilities

Provides written, verbal or face-to-face customer service to members by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
Resolves customer inquiries and complaints in a timely and accurate manner. Escalates issues as appropriate.
Processes routine medical, dental, life, Medicare, Medicaid and/or hospital claims in accordance with assigned Plan(s).
Conducts research in relation to member/client/management inquiries and documents findings.
Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
Consistently meets established performance quotas, including quantity and quality claims processing standards.
Utilizes multiple operating platforms and portals for research and claims processing.
Performs other related duties as assigned.