Zenith American Solutions specializes in third-party benefits administration for employers, with services encompassing health and welfare administration, customer care, claims serv
Claims Processor
Location
France
Posted
40 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Claims Processor
Zenith American Solutions
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. Working Conditions/Physical Effort - Prolonged periods of sitting at a desk and working on a computer. - Must be able to lift up to 15 pounds at times. Disability Accommodation Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com, and we would be happy to assist you. 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!
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By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Senior Adjuster - Construction Defect PRIMARY PURPOSE: To investigate and adjust property and casualty claims, both residential and commercial, with little to no supervision. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Inspects claims and contacts involved parties in a timely manner. - Investigates circumstances of claim(s) as required for coverage determination, cause, and compensable damages/reserves. - Examines insurance policies and other records to determine insurance coverage. - Prepares estimates for cost of repair and/or replacement. - Conducts interviews with claimant and witnesses regarding submitted claim(s). - Negotiates and settles both 1st and 3rd party claims. - Addresses salvage and subrogation as required by the client. - Maintains client relationships to assure repeated business referrals. ADDITIONAL FUNCTIONS and RESPONSIBILITIES - Performs other duties as assigned. - Supports the organization's quality program(s). - Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. IIA-AIC designation required. Appropriate state adjuster license is required. Experience Two (2) years of related experience or equivalent combination of education and experience required. Skills & Knowledge - Strong oral and written communication, including presentation skills - PC literate, including Microsoft Office products - Demonstrated commitment to timely reporting - Strong customer service skills - Strong interpersonal skills - Attention to detail and accuracy - Good time management and organizational skills - Ability to work independently or in a team environment - Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: - Must be able to stand and/or walk for long periods of time. - Must be able to kneel, squat or bend. - Must be able to work outdoors in hot and/or cold weather conditions. - Have the ability to climb, crawl, stoop, kneel, reaching/working overhead - Be able to lift/carry up to 50 pounds - Be able to push/pull up to 100 pounds - Be able to drive up to 4 hours per day. - Must have continual use of manual dexterity. Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
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