JOB TITLE:

Claims Support Specialist 1

DEPARTMENT:

Claims (Las Vegas Badura)

REPORTS TO:

Brooke Reid

JOB DUTIES:

Responsible for all phases of the Claims and Customer Service Department. Ensures the completeness, accuracy and objectives of the Claims and Customer Service Department and provide efficiency and effectiveness to the Operations.

Responsibilities include:

• Assist with auditing and processing of all claim types
• Completion and submission of all necessary audit reports to management
• Analyze and trend training needs arising from audit results and system issues
• Assist with special projects or related activities as assigned
• Proficient in reviewing and adjusting all types of claims
• Answer phones and handle walk-ins in a friendly, courteous an professional manner
• Perform back-up functions for multiple Claims and Customer Service jobs
• Identify potential problems/trends in processes and recommend changes for management review
• Identify potential problems and possible solutions for process improvement
• Must meet the department's quality and production standards for this job, as provided on the work standards grid.

JOB REQUIREMENTS:

• HS or GED
• Strong knowledge of interpreting Plan Documents including Eligibility, Exclusions, and Limitations
• Minimum 5 years' experience as a Claims Examiner, CSR or in department specialty jobs
• Strong knowledge of CPT, ICD-9 and HCPCS coding
• Strong working knowledge of claims and customer service systems

Mental/Visual Concentration or Manual Dexterity

• Requires normal concentration.
• Easily learned, simple movements.

Computer Operations

• Must be PC literate in MS Word, Excel and simple databases
• Proficient in company software which includes but is not limited to Contribution Accounting System (or equivalent), Encounter Tracking (or equivalent), Claims system, Electronic Reference (or equivalent)
• Typing scores of 35 WPM

COMPETENCIES:

Customer Focus

Understands customer needs, both internal and external, and looks for opportunities to provide the highest quality service.

Quality Focus

• Maintains appropriate documentation.
• Works with other employees/departments to ensure timely and quality service.
• Must meet the department's quality and production standards for this job.

Analysis

• Strong analytical/problem solving skills
• Strong research skills
• Mathematical proficiency required.

Planning

• Solid organizational skills.
• Ability to prioritize and multi-task.

Communication

• Solid written, verbal, and presentation skills.
• Communicates clearly and professionally with participants, co-workers, and vendors.

Interpersonal Relations

• Assists participants, co-workers, and vendors in a friendly, courteous, and professional manner.
• Possesses a strong work ethic and team player mentality.
• Uses courtesy in communication and working with others.
• Works with other employees/departments to ensure timely and quality service.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Patience and rapport with others required.

Teamwork

• Works well in a team environment with minimal supervision.
• Contributes to team tactics to meet defined goals.
• Supports a work environment that is conducive to team productivity.
• Accepts team decisions and works toward implementation.

Positive Attitude

• Highly motivated.
• Demonstrates flexibility and resilience when faced with multiple demands, shifting priorities, ambiguity, and rapid change.

Integrity

• Approaches all business decisions and actions guided by sound personal and professional beliefs.
• High level of credibility and confidentiality.
• Earns trust by dealing honestly and following through on commitments.

Testing Requirements

• Pre-employment test for new hires to ZAS
• Typing
• 10-key
• Claims and CS tests

SALARY:

6

BID INSTRUCTIONS:

Interested applicants should apply through our new ATS system

https: //zenithamerican.applicantpro.com/internaljobs/ by COB Friday, March 21, 2025. EMail

Recruiting@zenith-american.com If you have any questions. The link can also be found on our intranet.

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!