What are the responsibilities and job description for the Medical Claims Team Leader position at Zenith American Solutions, Inc.?
Position Summary
The Medical Claims Lead is essential in overseeing the team's operations, ensuring the accurate and timely processing of medical insurance claims by reviewing patient records, verifying billing codes, and identifying potential issues.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties And Responsibilities
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!
The Medical Claims Lead is essential in overseeing the team's operations, ensuring the accurate and timely processing of medical insurance claims by reviewing patient records, verifying billing codes, and identifying potential issues.
"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties And Responsibilities
- Keeping up to date with plan benefit changes.
- Enhance team strengths by providing coaching or training in areas where team members need improvement.
- Conduct weekly check-in meetings as needed for team members to ask questions, address claim processing issues, and assess workload.
- Handle challenging situations with a high level of professionalism.
- Ability to plan, distribute, and monitor the workload among the group to ensure all mail remains in compliance.
- Ability to plan and execute training for new and current adjusters, providing coaching until they fully function.
- Serve as a link between management and team members, ensuring clear communication and alignment of goals.
- Performs other duties as assigned.
- High school diploma or GED.
- 12 months of experience processing health and welfare claims.
- Strong understanding of medical billing codes (CPT, ICD-10) and insurance regulations.
- Possess a strong sense of integrity and a deep commitment to ensuring customer satisfaction.
- Ability to read, analyze, and interpret 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 an 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.
- Strong knowledge of the Basys system
- 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.
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift 15 pounds at times.
- Must work onsite during the same schedule as the team or as needed by management.
- May be subject to interruptions.
- Must be able to have flexible work schedule when workflow requires.
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!
