Zenith American Solutions
ClaimsProcessor
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Claims Processor at Zenith American Solutions. Skills: Claims processing, Customer service. Maintains 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, death, Life and AD&D, Workers’ Compensation, or disability”
Industry & Context.
Analyze and interpret general business materials, technical procedures, benefit plans and regulations
Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role, Prolonged periods of sitting at a desk and working on a computer, Must be able to lift up to 15 pounds at times
What They're Looking For.
Must Have
High 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 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 discretion, Computer proficiency including Microsoft Office tools and applications
Nice to Have
Experience working in a third-party administrator
What You'll Do.
Maintains current knowledge of assigned Plan(s) and effectively applies that knowledge in the payment of claims
Processes routine claims which could include medical
Workers’ Compensation
Provide customer service by responding to and documenting telephone
or in-person inquiries
Performs other duties as assigned
How You'll Work.
Communication Scope
Communicate clearly and professionally, both verbally and in writing
Full Job Description
## Position Summary The Claims Processor 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 Responsibilities * Maintains 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, death, Life and AD&D, Workers’ Compensation, or disability. * May provide customer service by responding to and documenting telephone, written, electronic, or in-person inquiries. * Performs other duties as assigned. ## ## Minimum Qualifications * High 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 discretion * Computer proficiency including Microsoft Office tools and applications. ## Preferred Qualifications * Experience 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
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