Coordinator- Claims

EyeMed Vision Care; Mason (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

EyeMed Vision Care in Mason, OH seeks a Full-Time Claims Coordinator to accurately process manual and complex claims, including coordination of benefits, Medically Necessary, resubmitted and EyeRoute claims. The role emphasizes meeting performance KPIs for production, cycle time, and quality.

Requirements include a High School diploma, 3+ years of data entry, and proficiency in Microsoft Office (Outlook, Word, Excel).

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.

Responsibilities

• Efficiently and accurately processes complex claims.
• Consistently achieves KPIs with respect to production, cycle time, and quality.
• Participates in claims project initiatives, including rework and/or payment integrity efforts.
• Adapts to process changes from new plans, benefit designs, regulatory changes, etc.
• Collaborates with manager and colleagues to provide strong customer service and communication with key interfaces.
• Maintains clear upward and downward communication to keep team informed.
• Meets or exceeds performance standards in productivity and accuracy.
• Works with supervisor on self-remediation when standards aren’t met.

Skills

Data entry

Communication skills

Customer service

Multi-tasking

Attention to detail

Education

Bachelor's degree

Tools

Facets

Filebound

EyeRoute

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).

This posting is for an existing vacancy within our business. Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

EssilorLuxottica complies with all applicable laws related to the application and hiring process. If you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email [e-mail] 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 in the US receive preference in accordance with Tribal Law.