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Claims Processor

Date:  Sep 2, 2021
Brand:  EyeMed Vision Care
Location: 

Mason, OH, US, 45040

Requisition ID: 445241 
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 Processor accurately and efficiently processes claims from source documents, maintaining compliance with the insurance plan requirements and with high regard for adhering to goals for quality and claims production rates. Also performs other simple processes requiring a basic knowledge of claims adjudication.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Efficiently and accurately processes a variety of vision insurance claims or adjustments.
  • Determines any special plan requirements prior to billing.
  • Reviews claims before entry for completeness and compliance with business requirements.
  • Effectively and accurately reviews images and transcribed data in the Vidado portal in preparation for auto adjudication.
  • Participates on special project initiatives, including rework efforts as needed.
  • Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
  • Maintains compliance with HIPAA guidelines and regulations.
  • Works with supervisor and co-workers to provide a high standard of customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
  • Partners with the Provider Relations team by providing information that is necessary to properly train the stores, providers and field management.
  • Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.

 

BASIC QUALIFICATIONS

  • High School diploma or equivalent work experience
  • 1+ year(s) of data entry experience

 

PREFERRED QUALIFICATIONS

  • Bachelor's degree
  • Claims processing experience
  • Strong customer service focus
  • Good verbal communication skills
  • Good written communication skills
  • Able to quickly grasp and retain information and concepts
  • Able to multi-task and prioritize issues
  • Strong attention to detail
  • Knowledge of Medicare/Medicaid business
  • Understand and honor high level of confidentiality
  • Knowledge of vision benefits and/or insurance industry
  • Proficient in Microsoft Word, Excel and Access
  • Working knowledge of interface systems such as Facets, EyeNet, and ExClaim

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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