Claims Processor Job in Seattle 98109, Washington US

We are currently seeking an experienced medical claims processor to join our Northwest Operations team in Seattle.  You will have responsibility for independently processing routine health claims on an assigned account including obtaining additional information from providers and members when necessary.

Responsibilities include:
 1.   Analyzes and determines extent of plan's liability concerning medical claims.
 2.   Calculates benefit payments and approves payment of claims.
 3.   Maintains a good understanding of claims processing guidelines, benefit structure, system procedures, and miscellaneous guidelines.
 4.   Calculates benefits and approves payment of claims.
 5.   Refers questionable claims to team lead.
 6.   Identifies potential problems/trends in processes to be escalated for management review.
 7.   Identifies potential problems and possible solutions for process improvement.
 8.   Creates, updates, and resolves logs in claims tracking system.

Requirements include:
 1.   High school diploma or equivalent.
 2.   Minimum 2 years group medical claims processing experience.
 3.   Thorough knowledge of claims processing and claims adjudication principles and procedures.
 4.   Thorough knowledge of medical and/or dental terminology and procedures and IDC-9/10 and CPT-4 codes.
 5.   Demonstrated ability to read and interpret plan documents.
 6.   Intermediate skills in Word; Excel experience preferred.
 7.   Data entry (minimum 35 WPM) and 10-key skills required.
 8.   Ability to consistently meet production and quality goals.
 9.   Strong verbal and written communication skills.
10. Excellent organizational skills.
11. Strong attention to detail.
12. Ability to interact effectively with others, including co-workers, management, clients, and plan members.
13. Taft-Hartley benefits administration and disability claims experience a strong plus.

Zenith American Solutions (recently formed by the merger of Zenith Administrators and American Benefit Plan Administrators) is a premier, national third party-administrator (TPA) for employee benefit plans.  We serve as administrator, manager or technology service vendor for corporate employers, government entities, trade associations, and Taft-Hartley benefit trust funds, through our national network of service centers. We currently have 1200+ employees located in 36 offices across the nation.  We combine technology and proven practices with national resources and a local presence for our clients.  Come and find out about the great things going on at Zenith American.

This is a full-time, 37.5 hour/week position in a bargaining unit.  Zenith American offers competitive pay and benefits, casual dress and more.  Send resume and cover letter referencing Job #040-2012 to careers@zenith-american.com or fax to (206) 216-3486, www.zenith-american.com, EOE.