Processor- Claims

EyeMed Vision Care; Mason (OH); On-site; USD 38,000 - 52,000; Full time

Job summary

EyeMed Vision Care in Mason, OH seeks a full-time Claims Processor to accurately process a variety of vision insurance claims and adjustments, ensuring compliance with plan requirements and quality targets. The role emphasizes data entry, review of claims, HIPAA compliance, and collaboration with Account Managers, Operations, and client teams to deliver reliable customer service.

Experience with Vidado portal and familiarity with benefits designs is a plus.

Qualifications

• High School diploma or equivalent work experience.
• 1+ year of data entry experience.
• Knowledge of Medicare/Medicaid business.
• Experience in vision benefits or insurance industry is a plus.
• Proficient in Microsoft Word, Excel and Access.
• Strong attention to detail and ability to maintain confidentiality.

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 in the Vidado portal for auto adjudication preparation.
• Participates on special project initiatives and rework efforts as needed.
• Operates processing changes from new plans and benefit designs.
• Maintains HIPAA compliance and protects confidential information.
• Collaborates with Account Managers, Operations, IS, Client Representatives and leadership.
• Provides information to Train stores, providers and field management.
• Contacts stores or providers to obtain additional information or follow up on claims.

Skills

Attention to detail

Verbal communication

Written communication

Multi-tasking

Prioritization

Customer service

Grasp new information

Confidentiality

Medicare/Medicaid knowledge

Education

High School diploma or equivalent

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Access

Facets

EyeNet

ExClaim

Job description

Requisition ID: 948164

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 Processor accurately and efficiently processes 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 simple processes requiring a basic knowledge of claims adjudication.

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 Vidado portal in preparation for auto adjudication.
• 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 a high standard of customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
• Partners with the Provider Relations team by providing information that is necessary to properly train the stores, providers and field management.
• Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.

Basic Qualifications

• High School diploma or equivalent work experience
• 1+ year(s) of data entry experience

Preferred Qualifications

• Bachelor's degree
• Claims processing experience
• Strong customer service focus
• Good verbal communication skills
• Good written communication skills
• Able to quickly grasp and retain information and concepts
• Able to multi-task and prioritize issues
• Strong attention to detail
• Knowledge of Medicare/Medicaid business
• Understand and honor high level of confidentiality
• Knowledge of vision benefits and/or insurance industry
• Proficient in Microsoft Word, Excel and Access
• Working knowledge of interface systems such as Facets, EyeNet, and ExClaim

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.