Coordinator- Claims

EssilorLuxottica; Mason (OH); On-site; USD 42,000 - 54,000; Full time

Job summary

EyeMed in Mason, OH is seeking a Claims Coordinator to accurately process all types of manual claims, including complex and benefit-related cases. The role emphasizes meeting KPIs for productivity, cycle time, and quality, with collaboration across EyeMed Account Managers, Operations, IT, and client representatives.

The position requires a high school diploma (or equivalent) and 3+ years of data entry experience, plus proficiency with Microsoft Office.

Qualifications

• High School diploma or equivalent work experience.
• 3+ years data entry experience.
• Proficiency in Microsoft Office (Outlook, Word, Excel).
• Ability to multitask and work under pressure.
• Flexibility to work in team and individually.

Responsibilities

• Process complex manual claims accurately.
• Consistently meet KPIs for production, cycle time, and quality.
• Participate in claims projects including rework and payment integrity.
• Adapt quickly to plan changes, benefit designs, and regulatory updates.
• Maintain strong customer service with EyeMed stakeholders.

Skills

Data entry

MS Office

Time management

Communication

Teamwork

Adaptability

Education

High School diploma or equivalent

Bachelor's degree (preferred)

Tools

Facets

EyeRoute

Filebound

Job description

Requisition ID:944725

Store #:110365 EM Claims Processing - OH CSC

Position:Full-Time

Total Rewards:Benefits/Incentive Information

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.

Our mission is to help people see life to the fullest-and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world's vision crisis.

EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

JOB DESCRIPTION

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).