Claims Processor

Creative Solutions Services, LLC; Mason (OH); On-site; USD 45,000 - 49,000; Full time

Benefits offered by this job

Paid weekly

Health, dental + vision insurance

Job summary

Creative Solutions Services, LLC is seeking an onsite Claims Processor in Mason, OH to handle a range of vision insurance claims from source documents, ensuring accuracy and HIPAA compliance while meeting quality and production goals.

This 3-month engagement ($22.55/hr, W2, paid weekly) offers benefits including health, dental, and vision insurance.

Work hours are 9-5, with potential extension based on performance and business needs.

Qualifications

• High School diploma or equivalent required.
• 3+ years of data entry experience.
• Strong customer service focus.
• Excellent verbal and written communication.
• Ability to multi-task and prioritize workload.
• Strong attention to detail.
• Knowledge of Medicare/Medicaid business desirable.
• Familiarity with vision benefits or insurance industry.
• Proficient in Microsoft Word, Excel and Access.

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.
• Reviews images and transcribed data for auto adjudication.
• Coordinate and complete claim error corrections.
• Maintains the Medicare/Medicaid Pend Claims process.
• Participates in special project initiatives, including rework efforts as needed.
• Implements processing changes resulting from new plans and benefit designs.
• Maintains HIPAA compliance.
• Works with supervisors and co-workers to provide strong customer service and communication with key interfaces.
• Assists Team Lead in a backup lead capacity.
• Assists with root cause analysis of claim issues for clients.
• Contacts stores or providers to obtain additional information or follow up on claims.

Skills

Data entry

Customer service

Verbal communication

Written communication

Multitasking

Attention to detail

Education

High School diploma or equivalent

Tools

Microsoft Word

Excel

Access

Job description

Position Title: Claims Processor/ONSITE

Location: 4000 LUXOTTICA PL Mason OH 45040

Work Hours: 9- 5pm

Pay Rate: $ 22.55/hr on W2 Paid Weekly!

Benefits: Paid weekly, health, dental + vision insurance available!

Preferred Start Date: 9/28/2026

Duration: 3month(s)/ Extension is possible based on performance, attendance, and business need)

Specific Skills Needed:

Top 3-5 mandatory and/or minimum requirements: see JD attached

Top 3-5 desirable attributes/qualifications?: see JD attached

GENERAL FUNCTION

The Claims Coordinator accurately and efficiently processes all types of 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 complex claim processing which include but not limited to Medicare/Medicaid Pend process, Corrected Claims, and running daily reports.

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 portal in preparation for auto adjudication.
• Coordinate and complete claim error corrections
• Maintains the Medicare/Medicaid Pend Claims process
• 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 strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
• Assists Team Lead in a backup lead capacity
• Assists with root cause analysis of claim issues to resolve thoroughly and completely for clients
• Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.

Position Title: Claims Processor/ONSITE

Location: 4000 LUXOTTICA PL Mason OH 45040

Work Hours: 9- 5pm

Pay Rate: $ 22.55/hr on W2 Paid Weekly!

Benefits: Paid weekly, health, dental + vision insurance available!

Preferred Start Date: 9/28/2026

Duration: 3month(s)/ Extension is possible based on performance, attendance, and business need)

Specific Skills Needed:

Top 3-5 mandatory and/or minimum requirements: see JD attached

Top 3-5 desirable attributes/qualifications?: see JD attached

GENERAL FUNCTION

The Claims Coordinator accurately and efficiently processes all types of 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 complex claim processing which include but not limited to Medicare/Medicaid Pend process, Corrected Claims, and running daily reports.

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 portal in preparation for auto adjudication.
• Coordinate and complete claim error corrections
• Maintains the Medicare/Medicaid Pend Claims process
• 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 strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
• Assists Team Lead in a backup lead capacity
• Assists with root cause analysis of claim issues to resolve thoroughly and completely for clients
• Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.

BASIC QUALIFICATIONS

• High School diploma or equivalent work experience
• 3+ year(s) of data entry experience
• Strong customer service focus
• Strong verbal & written communication skills
• Able to multi-task and prioritize issues
• Strong attention to details

PREFERRED QUALIFICATIONS

• Knowledge of Medicare/Medicaid business
• Knowledge of vision benefits and/or insurance industry
• Proficient in Microsoft Word, Excel and Access

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