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Senior Claims Research Analyst

Date:  Jun 9, 2022
Brand:  EyeMed Vision Care
Location: 

Mason, OH, US, 45040

Requisition ID: 675083 
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 Sr Analyst – Claims Research is responsible for escalated claims research questions/issues, supporting payment integrity and claims processes, leading claim research projects, report creation/maintenance and data analysis, and identifying & implementing claims automation processes with an emphasis on improving quality, timeliness and productivity. The Sr Analyst will drive cross-functional issue resolution and process improvement efforts with various functional areas in the organization.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Interfaces with internal contacts to research/resolve claims issues accurately and in a timely manner.
  • Utilizing reporting methods, conducts root cause analysis, provides summary of findings and trends to Claims leadership.
  • Proactively identifies process improvement/modifications necessary to improve quality and effectiveness & automation opportunities related to claims processing.
  • Manages the relationship with identified areas, including IT, to ensure successful implementation of new claims processes and automation
  • Provides oversight of claims research projects, under the direction of the Claims Research Manager; supports payment integrity processes managing large scale claims research and recovery efforts.
  • Delivers daily/monthly reporting of claims processing stats to Leadership; identifies issues that require immediate attention & works with internal/external partners to resolve timely.
  • Develops and maintains claim processing policies and desk level procedures are documented and current, ensuring controls and key compliance requirements are met. 

 

BASIC QUALIFICATIONS

  • Bachelor’s Degree, or equivalent work experience
  • 3+ years of claims research analysis or related experience
  • Knowledge and experience working with Facets
  • Familiarity with query writing and/or report building
  • Experience with Microsoft Office, Excel proficiency
  • Strong analytical skills

 

PREFERRED QUALIFICATIONS

  • Knowledge of SQL Data Extraction
  • Knowledge of Business Objects
  • Knowledge of Cura

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: Business Process, Management

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