Customer Service Claims Processor

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Title: Customer Service Claims Processor Department: Customer Service

Union: OPEIU 29 Grade: 17

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

• 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.

• High School Diploma or GED.
• One year of experience working on the Customer Service or Claims teams.
• Proficiency with MS Office tools and applications.

• 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.

Compensation: $27.00/hr

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.

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!