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EyeMed - Senior Analyst - Quality Assurance

Date: Aug 14, 2019

Location: Mason, OH, US, 45040

Company: Luxottica Group

Requisition ID: 107996 
Position:Full-Time

 

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, Target Optical and Sears 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 Quality Assurance Senior Analyst leads the resolution of member and provider complaints and appeals related to quality of care, access to care, and benefit determination. The Quality Assurance Senior Analyst takes the lead role in the implementation of designated QA processes and applications as well as implementation of process/system changes within the department, with delegated entities and other departments within organization

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Collaborates between other departments including Customer Care, Claims, and Legal to investigate and resolve member and provider complaints and appeals
  • Conducts ongoing analysis of data to seek out root cause drivers and identify opportunities to refine and continually improve process; report key findings to stakeholders
  • Identifies opportunities with recommendations for process improvements necessary to facilitate department functions
  • Assists in leading cross functional teams to address and resolve identified member, provider, or client satisfaction issues
  • Prioritizes and analyzes member/provider issues and seeks EyeMed’s Medical Director’s involvement as needed
  • Develops formal request and response letters and written summaries of cases including the facts of the case, resolution, and directions regarding member/provider education or actions
  • Maintains complete and accurate complaint and appeal records in the electronic database
  • Meets established quality and productivity standards in all areas of complaints and appeals, including client performance guarantees and all applicable state and federal regulations
  • Coordinates Complaints and Appeals Sub Committee meetings
  • Participates and leads in ongoing analysis of quality data to seek out root cause drivers of opportunities to improve overall department quality
  • Assists in leading process improvement efforts across the quality assurance team. Constructively challenges existing processes and searches for opportunities to improve processes.

 

BASIC QUALIFICATIONS

  • Bachelor's Degree
  • 3+ yrs of related experience
  • Ability to work well under pressure and handle multiple priorities simultaneously
  • Excellent interpersonal, oral and written communication skills
  • High level of professionalism and ability to deal with sensitive information
  • Strong problem-solving, analysis and issue resolution skills
  • Ability to work independently in a fast-paced environment, handle multiple assignments, establish priorities, and demonstrate excellent time management skills
  • Proficient in MS Office Applications and ability to learn department and job specific software systems
  • Healthcare experience

 

PREFERRED QUALIFICATIONS

  • Claims processing or medical/vision benefits and product experience
  • Project Management experience
  • Medical Claims coding experience
  • Business Objects reporting experience
  • Previous experience in a leadership or mentorship capacity
  • Prior experience collecting and analyzing complex data, recognizing assumptions, evaluating information and drawing logical conclusions
  • Demonstrated ability to learn new technology systems and query reporting

 

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 contact Talent Luxottica at  877-589-8253 (513-765-2256 outside of US) or email TalentLuxottica@luxotticaretail.com

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, religion, age, disability, sexual orientation, gender identity or expression, citizenship, 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.

Quality Assurance  

 


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