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Claims Coordinator

Date:  Jan 12, 2022
Brand:  EyeMed Vision Care
Location: 

Mason, OH, US, 45040

Requisition ID: 542082 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

 

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same.  And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

 

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.  In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands.  Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

 

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Claims Coordinator will accurately and efficiently process all types of manual claims.  The Coordinator will process complex claims, which includes coordination of benefits claims, Medically Necessary claims, resubmitted claims, EyeRoute claims, standard adjustments, VIP claims, complex manual workaround processes, claims rework projects, and daily reporting processes while ensuring key deliverables are met.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Efficiently and accurately processes complex claims
  • Consistently achieves key performance indicators with respect to production, cycle time, and quality
  • Participates on claims project initiatives, including rework and/or payment integrity efforts
  • Understands and quickly operationalizes process changes resulting from new plans, benefit designs, regulatory changes, etc.
  • Works with manager and co-workers to provide strong customer service and communication with key customer interfaces that include: EyeMed Account Managers, Operations, IT, Client Representatives and EyeMed leadership team
  • Frequent communication with internal associates and claims management. Ensure upward and downward communication to keep management and team members properly informed.
  • Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy.
  • Proactively works with supervisor to develop self-remediation plan when standards are not being met.

 

BASIC QUALIFICATIONS

  • High School diploma or equivalent work experience
  • 3+ year(s) of data entry experience
  • Knowledge and experience in Microsoft Office Products (Outlook, Word, Excel)
  • Ability to work well under pressure and multi-task
  • Flexibility working in both a team and individual environments
  • Ability to quickly grasp and retain information and concepts

 

PREFERRED QUALIFICATIONS

  • Bachelor's degree
  • Claims processing experience
  • Strong customer service focus
  • Good verbal & written communication skills
  • Able to quickly grasp and retain information and concepts
  • Able to multi-task and prioritize issues
  • Strong attention to details
  • Knowledge of Medicare/Medicaid business
  • Understand and honor high level of confidentiality
  • Knowledge of vision benefits and/or insurance industry
  • Working knowledge of interface systems that include: claims data entry processing system (Facets), workflow tools (Filebound and EyeRoute).

Upon request and consistent with applicable laws, Luxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner). 

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law.  Native Americans receive preference in accordance with Tribal Law.


Nearest Major Market: Cincinnati

Job Segment: Medicaid, Medicare, Data Entry, Healthcare, Administrative

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