Zenith American Solutions, Inc.
Supervisor, Claims
Zenith American Solutions, Inc., San Francisco, California, United States, 94199
Supervisor, Claims
Title:
Supervisor, Claims Department:
Claims Bargaining Unit:
NBU Grade:
N/A Position Type:
Exempt Hours per Week:
40
Position Summary:
The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with company guidelines, client needs, and regulatory requirements. The role involves ensuring compliance with privacy requirements for protected health information (PHI) and personally identifiable information (PII) as defined in the job description.
Key Duties and Responsibilities
Provides daily leadership and supervision to staff consistent with company values and mission.
Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
Develops staff through performance management, goal setting, training, and effective employee relations.
Maintains current knowledge of assigned plan(s) and applies it effectively in oversight of processing activities to ensure compliance.
Optimizes workflows, processes, tools, and staff allocation to ensure efficient and cost‑effective day‑to‑day operations.
Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy, and develops and distributes resource documents as needed.
Provides advanced technical review and support of claims processing as required, including:
Technical review of all types of claims, including large dollar and complex claims to validate benefit allowance and category.
Investigation, evaluation, and reporting on advanced cases for third‑party recovery, including stop‑loss, accident, medical malpractice, subrogation, and worker’s compensation.
Compiles documents, records, and data for external audits as requested.
Assists in the development and documentation of departmental SOPs.
Performs other duties as assigned.
Minimum Qualifications
High school diploma or GED.
Four years of experience processing complex health and welfare claims in a third‑party administrator.
One year of experience in a lead or supervisory role.
Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology, including ICD‑10 and CPT‑4 codes.
Thorough knowledge of claims operations, including payment of claims, interpretation of contracts, and communication of benefits.
Exceptional team player with confidence and integrity to earn client and internal team confidence quickly.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, both verbally and in writing.
Strong decision‑making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
Computer proficiency including Microsoft Office tools and applications.
Preferred Qualifications
Experience working in a multi‑employer or Taft‑Hartley environment.
This job description is not intended to be a comprehensive listing of all duties; duties 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, Zenith American Solutions provides reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy 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.
Compensation $80,000 per annum
Zenith American Solutions We are the largest independent third‑party administrator in the United States, operating over 44 offices nationwide. Since 1944, our organization has grown through mergers and innovation, delivering high‑quality work, exceptional service, and mutual respect. We offer a comprehensive benefits program, including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), and opportunities for growth.
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Supervisor, Claims Department:
Claims Bargaining Unit:
NBU Grade:
N/A Position Type:
Exempt Hours per Week:
40
Position Summary:
The Supervisor, Claims provides daily leadership and supervision to a Claims team in accordance with company guidelines, client needs, and regulatory requirements. The role involves ensuring compliance with privacy requirements for protected health information (PHI) and personally identifiable information (PII) as defined in the job description.
Key Duties and Responsibilities
Provides daily leadership and supervision to staff consistent with company values and mission.
Assigns, distributes, and monitors quality and quantity of work produced, ensuring employees are held accountable for consistently meeting quality and production requirements.
Develops staff through performance management, goal setting, training, and effective employee relations.
Maintains current knowledge of assigned plan(s) and applies it effectively in oversight of processing activities to ensure compliance.
Optimizes workflows, processes, tools, and staff allocation to ensure efficient and cost‑effective day‑to‑day operations.
Troubleshoots customer/client service issues and assists in the successful implementation of new clients.
Reviews and interprets new benefits plans or changes/updates to existing plans; tests benefits for validation and accuracy, and develops and distributes resource documents as needed.
Provides advanced technical review and support of claims processing as required, including:
Technical review of all types of claims, including large dollar and complex claims to validate benefit allowance and category.
Investigation, evaluation, and reporting on advanced cases for third‑party recovery, including stop‑loss, accident, medical malpractice, subrogation, and worker’s compensation.
Compiles documents, records, and data for external audits as requested.
Assists in the development and documentation of departmental SOPs.
Performs other duties as assigned.
Minimum Qualifications
High school diploma or GED.
Four years of experience processing complex health and welfare claims in a third‑party administrator.
One year of experience in a lead or supervisory role.
Advanced knowledge of benefits claims adjudication principles and procedures and medical and/or dental terminology, including ICD‑10 and CPT‑4 codes.
Thorough knowledge of claims operations, including payment of claims, interpretation of contracts, and communication of benefits.
Exceptional team player with confidence and integrity to earn client and internal team confidence quickly.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, both verbally and in writing.
Strong decision‑making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
Computer proficiency including Microsoft Office tools and applications.
Preferred Qualifications
Experience working in a multi‑employer or Taft‑Hartley environment.
This job description is not intended to be a comprehensive listing of all duties; duties 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, Zenith American Solutions provides reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy 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.
Compensation $80,000 per annum
Zenith American Solutions We are the largest independent third‑party administrator in the United States, operating over 44 offices nationwide. Since 1944, our organization has grown through mergers and innovation, delivering high‑quality work, exceptional service, and mutual respect. We offer a comprehensive benefits program, including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), and opportunities for growth.
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