Customer Service Claims Processor
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Overview
Job Description
Position Summary
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."
Key Duties and 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.
Minimum Qualifications
High School Diploma or GED.
One year of experience working on the Customer Service or Claims teams.
Proficiency with MS Office tools and applications.
Preferred Qualifications
Proficiency with conference software such as Zoom or Webex.
*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.
Please note that in compliance with certain state law, we are displaying salary. This rate is intended for hires into this location.
Compensation: $27.00/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!
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.
