Claims Processor

Title: Claims Processor Department: Claims

Bargaining Unit: UFCW 555 Grade: 3

Position Type: Non-exempt Hours per Week: 40

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 the employee of this job.

Duties, responsibilities and activities may change at any time with or without notice.

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 an...