Independently processes medical, dental and/or hospital claims, including more difficult or complex claims, provides customer service, and handles special projects and complex functions, including subrogation; acts as a "lead" and resource for other claims processing positions.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities

• Processes medical, dental and/or hospital claims; processes complex claims independently.
• Provides customer service by responding to and documenting telephone and/or written inquiries.
• Meets quantity and quality claims processing standards.
• Performs pre-authorizations, audits files, requests check tracers and stop payments, and assists with researching and preparing appeals, as applicable.
• Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in the payment of claims, customer service and all other job functions.
• Handle special duties and higher level, more complex functions (i.e. third party liability/subrogation, Flex, re-insurance, PPO updates, life insurance, etc.) as assigned.
• Acts as a resource or "lead" for all processor positions by answering questions, providing assistance, conducting training, and providing back-up on all other accounts.
• Consistently meets established performance standards and demonstrates excellent attendance and punctuality.
• Performs other related duties and special projects as assigned.

Working Conditions/Physical Effort

• Normal degree of physical effort in typical office environment with comfortable, constant temperatures and absence of objectionable elements.
• May be subject to interruptions.
• May be required to lift a maximum of 25 lbs.
• Must be able to have flexible work schedule when workflow requires.
• Must meet established attendance and punctuality guidelines.

Minimum Qualifications

• High School Diploma or Equivalent.
• Three years of experience processing all types of group medical, dental and hospital claims; in-depth knowledge of benefits, claims adjudication principles and procedures, medical and/or dental terminology and ICD-9 and CPT-4 codes.
• Excellent organizational skills, attention to detail, and ability to interact effectively with others.
• Effective oral and written communication skills.
• Excellent mathematical aptitude.
• Solid organization skills with strong detail orientation/high degree of accuracy.
• Possess a strong work ethic and the ability to work effectively in a team environment.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Ability to type 35 WPM and use a 10-key; proficient PC skills, including MS Word and Excel.
• Ability to perform well under pressure and to juggle many projects simultaneously.
• Excellent business writing skills.
• Ability to read, analyze and interpret general business materials, technical procedures, benefit plans and regulations.
• Able to maintain excellent attendance and punctuality.

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com, and we would be happy to assist you.

Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.

Compensation: $37.28/hr

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

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!