612 Claims Processor jobs in the United States

Job Description

The Claim Processor's primary responsibility is the timely and accurate processing of claims and prior approvals. The Claim Processor ensures compliance with client's program specifications and ACB policies and procedures. Specific Claim Processor duties may be dependent on the client(s) they support. Claim Processors must effectively manage their time and workload to ensure all service levels are maintained (i.e. claims and prior approvals are processed accurately, communications related to claims and prior approvals are thorough and that processing occurs within the contractual turnaround time). The Claim Processor may also assist with customer service via telephone, email, and/or fax, special projects and the preparation of reports (routine and/or ad hoc).

DUTIES

Process claims and prior approvals accurately and in a timely manner. Processing may include the measurement of ads, verification of advertising rates based on research data or actual invoices, performance of mathematical calculations, comparing advertising content to client's program guidelines to ensure compliance, preparation of input sheets and/or entering audit results into the client's processing database or web application.

QUALIFICATIONS

High School Diploma or equivalent certificate. Basic PC knowledge, including Microsoft Office products; Outlook, Word, and Excel. General mathematical, spelling and grammar skills as demonstrated by successful completion of pre-employment tests. Basic understanding of accounting principles. A minimum of one year work experience is desired Previous experience in a customer service or clerical production environment is preferred. Strong organizational and time management skills are needed to manage multiple tasks/priorities. M-F 8:00 - 4:15.

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.

• Experience working in a third-party administrator.

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!

Job Title: Health Claims Processor

Location: Valencia, CA (or remote)

Job Type: Full-Time

About Us: PayForward is dedicated to providing exceptional service to our clients. We specialize in managing Medicare Advantage plans and are committed to ensuring our clients and their members receive the best possible care and support.

Job Description: We are seeking a dedicated and detail-oriented Health Claims Processor to join our team. The primary responsibility of this role is to process claims reimbursements for our client's Medicare Advantage plans. The ideal candidate will also be flexible and willing to take on additional tasks as needed to support our team and clients.

Key Responsibilities:

· Process claims reimbursements and related inquiries accurately and efficiently.

· Communicate with members and colleagues to gather necessary information and provide updates on claim status.

· Resolve inquiries and issues related to claims and reimbursements.

· Maintain detailed and organized records of all claims and communications.

· Collaborate with other team members to ensure seamless service delivery.

· Assist with other administrative tasks and projects as needed.

Qualifications:

· High school diploma or equivalent; additional education or certifications in healthcare administration or related fields is a plus.

· Previous experience in customer service, preferably in the healthcare or insurance industry.

· Strong attention to detail and organizational skills.

· Excellent communication and interpersonal skills.

· Ability to work independently and as part of a team.

· Proficiency in Microsoft Office Suite and other relevant software.

Benefits:

· Competitive salary

· Health, dental, and vision insurance

· Paid time off and holidays

· Opportunities for professional development and advancement

PayForward is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Job Type: Full-time

Pay: $45, $55,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: Remote